發(fā)布時(shí)間：2018-04-12 07:26

  本文選題：造血干細(xì)胞移植 + 血液腫瘤　； 參考：《重慶醫(yī)學(xué)》2016年02期

【摘要】：目的分析異基因造血干細(xì)胞移植(allo-HSCT)治療惡性血液病的療效及安全性,探討移植相關(guān)并發(fā)癥及影響預(yù)后的因素。方法回顧性分析2010年6月至2015年6月貴州醫(yī)科大學(xué)附屬醫(yī)院造血干細(xì)胞移植中心行allo-HSCT的150例惡性血液病患者的病歷資料。按照供者類型不同,將其分為同胞全相合移植組(n=52)和單倍體移植組(n=98)。所有患者均采用改良白消安/環(huán)磷酰胺(BU/CY)為預(yù)處理方案,單倍體移植組加用兔抗人胸腺細(xì)胞免疫球蛋白(ATG),移植物抗宿主病(GVHD)的預(yù)防采用短療程甲氨蝶呤+環(huán)孢素A+嗎替麥考酚酯,對(duì)150例患者療效、安全性及移植相關(guān)并發(fā)癥進(jìn)行分析。結(jié)果 150例患者經(jīng)血型、染色體或DNA多態(tài)性檢測(cè)證實(shí)均達(dá)到完全供者細(xì)胞植入,同胞全相合移植組平均中性粒細(xì)胞及血小板重建時(shí)間為移植后12d和16d,單倍體移植組平均中性粒細(xì)胞及血小板重建時(shí)間為移植后13d和16d。150例患者中,59例(39.3%)患者出現(xiàn)口腔黏膜潰瘍,47例(31.3%)患者移植后100d內(nèi)發(fā)生細(xì)菌和(或)真菌感染,41例(27.3%)患者移植后100d內(nèi)發(fā)生巨細(xì)胞病毒感染,48例(32.0%)患者發(fā)生急性GVHD,43例(28.7%)患者發(fā)生慢性GVHD。隨訪1~60個(gè)月,中位隨訪時(shí)間23個(gè)月。115例(76.7%)患者無(wú)病存活,其中同胞全相合移植組38例(73.1%,38/52),單倍體移植組77例(78.6%,77/98)。35例(23.3%,35/150)患者死亡,其中同胞全相合移植組死亡14例(26.9%,14/52),單倍體移植組死亡21例(21.4%,21/98)。死因分析發(fā)現(xiàn),12例(8.0%)因移植相關(guān)并發(fā)癥死亡,其中5例(3.3%)因嚴(yán)重感染,7例(4.7%)因急性GVHD;23例(15.3%)患者因原發(fā)病復(fù)發(fā)死亡。兩組患者生存率及死亡率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 allo-HSCT治療惡性血液病安全有效,單倍體移植的療效與安全性接近全相合移植,急性GVHD和感染是嚴(yán)重影響移植療效和預(yù)后的危險(xiǎn)因素,需早期預(yù)防。
[Abstract]:Objective to analyze the efficacy and safety of allo-HSCT in the treatment of malignant hematological diseases, and to explore the related complications and prognostic factors of allogeneic hematopoietic stem cell transplantation (HSCT).Methods from June 2010 to June 2015, the medical records of 150 patients with malignant hematologic diseases were retrospectively analyzed in the Hematopoietic Stem Cell Transplantation Center of affiliated Hospital of Guizhou Medical University.According to the type of donor, it was divided into two groups: sibling homozygous transplantation group and haploid transplantation group.All of the patients were treated with modified Baoxifen / Cyclophosphamide butadiene (BU / CYR) regimen.In the haploid transplantation group, the short course of methotrexate A motimicol ester was used in the prevention of rabbit anti-human thymocyte immunoglobulin (ATGG) and graft-versus-host disease (GV HDD). The efficacy, safety and transplantation related complications of 150 patients were analyzed.Results all the 150 patients were confirmed by blood type, chromosome or DNA polymorphism to be completely donor cell implantation.The mean mean neutrophil and platelet reconstruction time in the sib group was 12d and 16d after transplantation, and the mean neutrophil and platelet remodeling time in haploid group was 39.3% (59 / 13d).Bacterial and / or fungal infection was found in 41 patients within 100 days after transplantation. There were 48 patients with cytomegalovirus infection within 100 days after transplantation and 48 patients with cytomegalovirus infection.) 43 patients with acute GV HDV developed acute GV HDD (43 patients with GVHD) developed chronic GVHD.Among them, 14 cases died in the sibling complete homograft group (26.9%) and 21 cases in the haploid transplantation group (21 / 21 / 98).The causes of death were as follows: 12 cases (8.0%) died as a result of transplantation related complications, 5 cases (3.3%) and 7 cases (4.7%) due to severe infection) and 23 cases (15.3%) of acute GVHD) died of primary disease.There was no significant difference in survival rate and mortality between the two groups (P 0.05).Conclusion allo-HSCT is safe and effective in the treatment of malignant hematologic diseases, and the effect and safety of haploid transplantation are close to that of complete matching transplantation. Acute GVHD and infection are the risk factors which seriously affect the curative effect and prognosis of transplantation, and need to be prevented early.
【作者單位】： 貴州醫(yī)科大學(xué)附屬醫(yī)院血液科/貴州省造血干細(xì)胞移植中心;貴州省安順市人民醫(yī)院血液科;
【基金】：國(guó)家自然科學(xué)基金資助項(xiàng)目(81070444,81270636) 貴陽(yáng)市科技局筑科合同(筑科合同[20141001]47號(hào))
【分類號(hào)】：R457.7

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