本文選題：費(fèi)城染色體 + 前體細(xì)胞淋巴母細(xì)胞白血病淋巴瘤��； 參考：《中國組織工程研究》2017年25期

【摘要】：背景:隨著移植方案的優(yōu)化及移植物抗宿主病治療藥物的出現(xiàn),使得異基因造血干細(xì)胞移植近年來取得了巨大的進(jìn)步,為越來越多的惡性血液病患者爭取了長期生存的機(jī)會。目的:比較3種移植方式即同胞全相合、無關(guān)供體全相合及親緣間單倍型異基因造血干細(xì)胞移植治療伴有費(fèi)城染色體急性淋巴細(xì)胞白血病(Ph+ALL)的療效和安全性。方法:2006年6月至2013年11月間,69例伴有費(fèi)城染色體急性淋巴細(xì)胞白血病患者接受異基因造血干細(xì)胞移植。同胞全相合移植23例,無關(guān)供體全相合移植24例,親緣間單倍型移植22例;其中54例為CR1狀態(tài),12例為CR2到CR4狀態(tài),3例復(fù)發(fā)狀態(tài)。獲取供者骨髓干細(xì)胞或者外周血干細(xì)胞用于移植。預(yù)處理方案為阿糖胞苷、白消安、環(huán)磷酰胺及全身照射等。聯(lián)合使用環(huán)孢素A+短程甲氨蝶呤+嗎替麥考酚酯+抗人胸腺細(xì)胞球蛋白等預(yù)防移植物抗宿主病。結(jié)果與結(jié)論:(1)68例患者獲得造血重建,僅1例單倍型植入失敗;(2)患者隨訪時間中位數(shù)為20.4個月,同胞全相合、無關(guān)供體全相合及親緣間單倍型移植的急性移植物抗宿主病發(fā)生率分別為30%,33%及45%,慢性移植物抗宿主病發(fā)生率22%,29%及36%,各組間急性移植物抗宿主病、慢性移植物抗宿主病發(fā)生率比較差異無顯著性意義;(3)同胞全相合、無關(guān)供體全相合及親緣間單倍型移植的移植相關(guān)死亡率為9%,29%及41%,各組間比較差異有顯著性意義(0.01P0.05)。復(fù)發(fā)率為17%,21%及14%,各組間比較差異無顯著性意義;(4)同胞全相合、無關(guān)供體全相合及親緣間單倍型移植的3年總體生存率為68%,49%及43%,同胞全相合組與無關(guān)供體全相合組、同胞全相合與親緣單倍型組分別比較,差異有顯著性意義(P均0.05),而無關(guān)供體全相合與親緣間單倍型移植比較差異無顯著性意義;(5)54例CR1狀態(tài)移植患者3年總體生存率為58%;15例于非CR1狀態(tài)移植患者3年總體生存率為41%;(6)結(jié)果表明,同胞全相合移植療效優(yōu)于無關(guān)供體全相合及單倍型移植;CR1狀態(tài)下行異基因造血干細(xì)胞移植的療效顯著優(yōu)于CR2以上狀態(tài)。
[Abstract]:Background: with the development of graft versus host disease (GVHD) therapy, allogeneic hematopoietic stem cell transplantation (HSCT) has made great progress in recent years. Objective: to compare the efficacy and safety of allogeneic hematopoietic stem cell transplantation with allogeneic haplotype in the treatment of Philadelphia chromosome acute lymphoblastic leukemia (Ph ALL). Methods: from June 2006 to November 2013, 69 patients with Philadelphia chromosome acute lymphoblastic leukemia received allogeneic hematopoietic stem cell transplantation. There were 23 cases of sibling homozygous transplantation, 24 cases of unrelated donor complete matching transplantation, 22 cases of allogeneic haplotype transplantation, among which 54 cases were CR1 status and 12 cases were CR2 to CR4 status. Obtain donor bone marrow stem cells or peripheral blood stem cells for transplantation. The pretreatment regimen was cytarabine, salicylate, cyclophosphamide and whole body irradiation. Combined use of cyclosporine A short course methotrexate against human thymocyte globulin was used to prevent graft-versus-host disease. Results the median follow-up time was 20.4 months in 68 patients with hematopoietic reconstitution and only one patient with haplotype failed implantation. The incidence of acute graft-versus-host disease was 30% and 45% in unrelated donors and haplotypes transplantation respectively, and the incidence of chronic graft versus host disease was 22 9% and 36%, respectively. Acute graft-versus-host disease was found in each group. There was no significant difference in the incidence of chronic graft-versus-host disease. There was no significant difference in the incidence of chronic graft-versus-host disease. There was no significant difference between the two groups. The transplant mortality of unrelated donors and haplotypes were 9% and 41%, respectively. There was a significant difference between the two groups (0.01 P 0.05). The recurrence rate was 17% and 14%. There was no significant difference between the two groups. The overall survival rate of unrelated donors and unrelated haplotypes was 6849% and 43% respectively. The sibling homozygous and relative haplotypes were compared, There was no significant difference between donor complete matching and allogeneic haplotype transplantation. There was no significant difference in 3-year survival rate of 554 CR1 patients with CR1 status transplantation. The overall 3-year survival rate of 15 patients with non-CR1 status transplantation was 58.15 patients with non-CR1 status transplantation had a 3-year overall survival rate. The survival rate was 41 / 6). The therapeutic effect of sibling homozygous transplantation was better than that of allogeneic hematopoietic stem cell transplantation under CR1 condition.
【作者單位】： 蘇州大學(xué)附屬第一醫(yī)院江蘇省血液研究所衛(wèi)生部血栓與止血重點(diǎn)實(shí)驗(yàn)室血液學(xué)協(xié)同創(chuàng)新中心;蘇州市市立醫(yī)院ICU;
【基金】：江蘇省科教興衛(wèi)工程-臨床醫(yī)學(xué)中心(ZX201102) 國家臨床重點(diǎn)專科建設(shè)項(xiàng)目 衛(wèi)生公益性行業(yè)科研專項(xiàng)經(jīng)費(fèi)項(xiàng)目(201202017)~~
【分類號】：R733.71

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