Haploidentical hematopoietic stem cell transplantation for leukemia in 23 cases

doi:10.3969/j.issn.2095-4344.2016.28.017

Abstract

Abstract:

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) is one of the effective methods in the treatment of leukemia. The haploidentical HSCT is an option for the patients who need a HSCT without a human leukocyte antigen (HLA)-matched donor.
OBJECTIVE: To study the clinical efficacy of HLA-haploidentical HSCT on leukemia and its complications.
METHODS: A total of 23 patients (4 cases of acute lymphoblastic leukemia, 12 of acute myelogenous leukemia, and 7 of chronic granulocytic leukemia) who had been treated with HLA-haploidentical HSCT from November 2007 to March 2015 were enrolled. Conditioning regimen I was set as cyclohexyl nitrosourea+cytarabine+busulfan+cyclophosphamide; regimen II as cyclophosphamide+total body irradiation; regimen III as fludarabine+cytarabine+busulfan+cyclophosphamide; and regimen IV as busulfan+cyclophosphamide. Cyclosporin A, mycophenlate mofetil, antithymocyte globulin and methotrexate were used to prevent graft-versus-host disease (GVHD). Hematopoietic remodeling, complications and prognosis were observed in all patients undergoing HLA-haploidentical HSCT.
RESULTS AND CONCLUSION: Of the 23 patients, 22 achieved reconstitution of the granulocyte series, and 19 achieved reconstruction of the megakaryocyte series. Additionally, there were 7 cases of acute GVHD and 4 of chronic GVHD. Transplant-related mortality was 22% (5/23) within 100 days post transplantation including graft failure, acute GVHD, intracranial hemorrhage and disseminated infections. There were 14 cases of disease-free survival from 100 days to 24 months post transplantation, 2 cases of death due to GVHD and fungal infection, or recurrence and chronic GVHD, and 2 cases of recurrence under treatment. These findings indicate that HLA-haploidentical HSCT is an effective approach for the treatment of patients with leukemia, which is worth further investigation in clinical practice.

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: Hematopoietic Stem Cell Transplantation, Leukemia, Graft vs Host Disease, Tissue Engineering

CLC Number:

R394.2

Jiang Qu, Zhang Hong-bin, Yang Li, Luo Hong, Miao Qiao, Deng Xue-mei . Haploidentical hematopoietic stem cell transplantation for leukemia in 23 cases[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(28): 4218-4225.

Figures/Tables 2

2.2.1 移植物抗宿主病发生情况移植后100 d内，急性移植物抗宿主病发生7例，发生率为30%(7/23)。仅发生皮肤Ⅰ-Ⅱ度急性移植物抗宿主病4例，给予甲泼尼龙2 mg/(kg•d)治疗后缓解；同时发生皮肤及肠道Ⅰ-Ⅱ度急性移植物抗宿主病1例，予以甲泼尼龙联合CD25单抗治疗后缓解；1例+8 d发生皮肤Ⅰ度急性移植物抗宿主病，予以甲泼尼龙治疗好转，+15 d发生肠道Ⅲ-Ⅳ度急性移植物抗宿主病，予以甲泼尼龙联合CD25单抗治疗无缓解；1例移植后17 d发生肠道Ⅳ度急性移植物抗宿主病，于+31 d发生肝脏Ⅱ度急性移植物抗宿主病，予以甲泼尼龙联合CD25单抗治疗无效。移植100 d后，18例可评价患者，4例发生慢性移植物抗宿主病，发生率为22%(4/18)。2例局限性慢性移植物抗宿主病，给予甲泼尼龙治疗后均缓解；2例广泛性慢性移植物抗宿主病，均有急性移植物抗宿主病史，1例原发疾病复发，治疗无效死亡，1例引起肾功能衰竭死亡。 2.2.2 感染 1例发生巨细胞病毒肺炎，抗病毒治疗后缓解，1例发生重症感染，致多器官功能衰竭死亡，1例发生严重肺部真菌感染，治疗无效，于移植后108 d死亡，2例移植100 d后发生带状疱疹病毒感染，予以抗病毒及对症支持治疗后缓解。1例患者发生卡氏肺孢子虫肺炎，给以甲泼尼龙联合复方磺胺甲恶唑治疗后缓解。1例移植1+年后发生肺部真菌感染，治疗后无缓解。 2.2.3 其他 10例患者出现出血性膀胱炎，给予水化、碱化、抗病毒等治疗后，病情缓解。1例发生血栓性微血管病变，予以甲泼尼龙治疗后无缓解。所有患者均未发生肝静脉闭塞症。 2.3 复发及生存情况移植后100 d内存活率为78.3%(18/23)，死亡5例。100 d至2年无病生存率60.9%(14/23)。有4例复发，复发率17.4%。至今，无病生存12例，其中无病生存5年及以上者4例，最早移植者至今已有8+年。Kaplan-Meier生存分析见图1。"

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