中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (32): 6052-6055.doi: 10.3969/j.issn.1673-8225.2010.32.036

• 干细胞临床实践 clinical practice of stem cells • 上一篇    下一篇

人类白细胞抗原配型不合造血干细胞移植治疗骨髓增生异常综合征15例

张  媛，陈惠仁，何学鹏，楼金星，刘晓东，郭  智，杨  凯，陈  鹏   

  1. 解放军北京军区总医院血液科，北京市   100700
  • 出版日期:2010-08-06 发布日期:2010-08-06
  • 通讯作者: 陈惠仁，博士，主任医师，解放军北京军区总医院血液科，北京市 100700
  • 作者简介:张媛☆，女，1977年生，山西省大同市人，汉族，2009年山西医科大学毕业，博士，主治医师，主要从事造血干细胞移植研究。 zhangyuan2004417@163.com

Human leukocyte antigen-mismatched hematopoietic stem cell transplantation in 15 patients with myelodysplastic syndromes 

Zhang Yuan, Chen Hui-ren, He Xue-peng, Lou Jin-xing, Liu Xiao-dong, Guo Zhi, Yang Kai, Chen Peng   

  1. Department of Hematology, General Hospital of Beijing Military Area Command of Chinese PLA, Beijing  100700, China
  • Online:2010-08-06 Published:2010-08-06
  • Contact: Chen Hui-ren, Doctor, Chief physician, Department of Hematology, General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China
  • About author:Zhang Yuan☆, Doctor, Attending physician, Department of Hematology, General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China zhangyuan2004417@163.com

PDF

553

被引次数

5

摘要：

背景：骨髓增生异常综合征是一组异质性的髓系肿瘤，易向白血病转化。异基因造血干细胞移植为治愈该病提供了可能性。
目的：通过观察人类白细胞抗原配型不合造血干细胞移植治疗骨髓增生异常综合征患者的反应，评价该方法的疗效和安全性。
方法：15例骨髓增生异常综合征患者均接受人类白细胞抗原配型不合造血干细胞移植，预处理方案包括阿糖胞苷、白消安、氟达拉滨及甲基环己亚硝脲。移植后给予抗胸腺细胞球蛋白、环孢素A、吗替麦考酚酯、甲氨蝶呤等预防移植物抗宿主病。 
结果与结论：15例患者中有14例移植后造血完全重建，中性粒细胞≥0.5×109L-1的中位时间为移植后16 d，血小板≥   20×109 L-1的中位时间为移植后20 d；1例患者植入失败，后接受二次移植，于移植后+14 d获造血重建。随访14(1~36)个月，1例死于肺部感染；1例于移植后12个月复发，经供者淋巴细胞输注及化疗获完全缓解；累积存活率为93.3%。8例患者在移植后出现急性移植物抗宿主病，发生率为57.1%；2例经免疫抑制剂治疗后病情得以控制，6例发生慢性移植物抗宿主病。结果表明，造血干细胞移植是治疗骨髓增生异常综合征的有效方法，可使多数患者得以长期生存。

关键词: 人类白细胞抗原配型不合, 造血干细胞, 细胞移植, 骨髓增生异常综合征, 移植物抗宿主病

Abstract:

BACKGROUND: Myelodysplastic syndromes (MDS), a series of heterogenicity myeloblastic tumor, have transformed to leucemia easily. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only possible treatment for curing this disease.
OBJECTIVE: To observe the therapeutic effect and complication of human leucocyte antigen (HLA)-mismatched HSCT for MDS, and to evaluate the outcome and safety of this treatment.
METHODS: A total of 15 patients with MDS were treated with HLA-mismatched HSCT. The conditioning regimen contained arabinosylcytosin, busulfan, fludarabine and methyl chlorethyl-cyclohexyl-nitrosourea. Antithymocyte globulin, ciclosporin A, mycophenolate mofetil and methotrexate were used for preventing graft versus host disease (GVHD).
RESULTS AND CONCLUSION: Among 15 patients, 14 received hematopoietic recovery after HSCT. The median time of granulocyte recovery ≥ 0.5×109/L and platelets ≥ 20×109/L were day 16 and day 20 respectively. One patient accepted the second time HSCT after failing of the first treatment, and received hematopoietic recovery on day 14 following transplantation. A total of 14 cases survived for a median of 14 (1-36) months, and one died from pulmonary infection, accumulated survival rate was 93.3%. One patient relapsed in 12 months after HSCT, and received complete remission after accepted donor lymphocyte infusion and chemotherapy. Eight patients occured acute GVHD (aGVHD) after HSCT, resulting in the incidence rate of 57.1%. Two of them were controlled after treatment with immunodepressant, and the remaining six developed chronic GVHD (cGVHD). Results suggested that HSCT is an effective treatment for MDS patients, and a majority of patients can survive for a long time.

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