中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (41): 6683-6687.doi: 10.3969/j.issn.2095-4344.2015.41.022

• 干细胞移植 stem cell transplantation • 上一篇    下一篇

免疫耐受新方法单倍型造血干细胞移植治疗重型再生障碍性贫血

郭 智，陈惠仁，杨 凯，刘晓东，楼金星，何学鹏   

  1. 解放军北京军区总医院血液科，北京市 100700
  • 出版日期:2015-10-01 发布日期:2015-10-01
  • 通讯作者: 陈惠仁，主任医师，教授，博士生导师，解放军北京军区总医院血液科，北京市 100700
  • 作者简介:郭智，男，1977年生，湖北省武汉市人，2000年同济医科大学毕业，硕士，副主任医师，副教授，硕士生导师，主要从事造血干细胞移植工作。
  • 基金资助:

    国家自然科学基金：DKK-1在间充质干细胞诱导免疫耐受机制中的调控作用(31200686)；北京市首都临床特色课题：诱导耐受新方法造血干细胞移植治疗重型再生障碍性贫血的临床研究(Z151100004015218)

A new method of inducing immune tolerance for haplotype hematopoietic stem cell transplantation in the treatment of severe aplastic anemia

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

  1. Department of Hematology, General Hospital of Beijing Military Area, Beijing 100700, China
  • Online:2015-10-01 Published:2015-10-01
  • Contact: Chen Hui-ren, Chief physician, Professor, Doctoral supervisor, Department of Hematology, General Hospital of Beijing Military Area, Beijing 100700, China
  • About author:Guo Zhi, Master, Associate chief physician, Associate professor, Master’s supervisor, Department of Hematology, General Hospital of Beijing Military Area, Beijing 100700, China
  • Supported by:

    the National Natural Science Foundation of China, No. 31200686; the Special Clinical Project of the Capital, No. Z151100004015218

PDF

257

被引次数

6

摘要：

背景：异基因造血干细胞移植是根治重型再生障碍性贫血的有效手段，尤其单倍型造血干细胞移植是具有中国特色的移植体系，在国际上处于领先水平。
目的：探索免疫耐受新方法单倍型异基因造血干细胞移植治疗重型再生障碍性贫血的模式，解决移植后排斥和移植物抗宿主病问题。
方法：解放军北京军区总医院血液科在2013年4月至2014年5月期间采用单倍型供者造血干细胞移植治疗重型再生障碍性贫血患者12例，单倍型供者采集经动员的骨髓及外周血干细胞，预处理方案中给予环磷酰胺400 mg/m2，连续用3 d，移植后+3 d用环磷酰胺诱导免疫耐受，剂量为50 mg/kg。
结果与结论：粒细胞植活中位时间17(13-21) d，血小板植活中位时间21(15-31) d。全部患者移植后发生Ⅱ度急性移植物抗宿主病1例，慢性广泛性移植物抗宿主病1例，经治疗后控制。所有存活患者最少随访时间在6个月以上，中位随访时间11个月，死亡2例，其中1例死于排斥反应，另1例死于肺部严重感染，其余10例随访期间生存。结果表明诱导免疫耐受新方法单倍型造血干细胞移植可减少移植物抗宿主病和移植相关病死率，取得了显著成效。
中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 干细胞, 移植, 环磷酰胺, 免疫耐受, 异基因造血干细胞移植, 移植物抗宿主病, 重型, 再生障碍性贫血, 国家自然科学基金

Abstract:

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective mean to cure severe aplastic anemia, and especially haplotype transplantation is regarded as a transplantation system with Chinese characteristics, and rank at the international leading level.
OBJECTIVE: To explore the patterns of haplotype allo-HSCT as a new immune tolerance method for severe aplastic anemia and to solve the transplantation rejection and graft-versus-host disease.
METHODS: Twelve patients with severe aplastic anemia who underwent haplotype allo-HSCT at the Department of Hematology, General Hospital of Beijing Military Area, China from April 2013 to May 2014 were enrolled. All 
these patients received the new regimen of inducing immune tolerance through the application of high-dose cyclophosphamide (400 mg/m2, consecutively 3 days before transplantation; 50 mg/kg, consecutively 3 days after haplotype transplantation).
RESULTS AND CONCLUSION: The median time of neutrophil recovery was 17 (13-21) days, and the median time of platelet recovery was 21 (15-31) days. After transplantation, there were one case of degree II acute graft-versus-host disease and one case of chronic graft-versus-host disease, both of which were controlled. The follow-up time was 6 months at least, and the median time was 11 months. During the follow-up, one case died of rejection reaction and one case died of severe lung infection. These findings indicate that the new method of inducing immune tolerance with high-dose cyclophosphamide after transplantation for severe aplastic anemia has significant effects in reducing graft-versus-host disease and transplantation-related mortality rate. 
中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

Key words: Anemia, Aplastic, Hematopoietic Stem Cell Transplantation, Cyclophosphamide, Immune Tolerance, Tissue Engineering