摘要
目的 探讨供者用粒细胞集落刺激因子 (G CSF)和受者联合应用多种免疫抑制剂治疗的单倍体骨髓移植在降低重症移植物抗宿主病 (GVHD)和改善无病生存的疗效。方法 单倍体骨髓移植治疗白血病 13例 (单倍体移植组 ) ,移植后结果和连续完成的 13例白血病HLA匹配异基因移植(相合移植组 )相比较 ,单倍体移植方法是供者应用G CSF 2 5 0 μg/d ,连用 7d后采髓 ,受者GVHD预防除环孢素A(CSA)和甲氨蝶呤 (MTX)外 ,在移植前 4～ 1d用抗胸腺细胞球蛋白 (ATG) 5mg·kg-1·d-1,移植后 7d始加服霉酚酸酯 (MMF)。结果 单倍体移植组植入物CD+ 3 4 细胞中位数 6 1× 10 6/kg,是相合移植组输入CD+ 3 4 细胞中位数 2 5× 10 6/kg的 2倍多 (P <0 0 1) ,单倍体移植组和相合移植组植入物CD+ 3 细胞中位数分别是 5 0 5× 10 6/kg和 4 7 0× 10 6/kg(P >0 0 5 )。移植后无 1例发生植入失败 ,两组造血重建速度无差异 (P >0 0 5 ) ,所有患者经骨髓植活直接证据检测证实为完全供者造血。单倍体移植组发生急性Ⅱ～ⅣGVHD 5例 (38 5 % ) ,可评价的 8例中 7例发生慢性GVHD(87 5 % ) ,为局限性慢性GVHD ,这与相合移植组差异无显著性 (P >0 0 5 )。单倍体移植组中位随访 4 5 3d(180～6 90 ) ,移植相关死亡 5例 ,无复发死亡病例 。
Objective To explore the effects of reducing the incidence of severe acute graft versus host disease (GVHD) and improving the disease free survival( DFS) in haploidentical donor transplantation by granlocyte colony stimulating factor (G CSF) administration to donor before harvesting and a number of immunosuppresants added to host Methods Thirteen patients with leukemia received allo bone marrow transplantation (BMT) from two or three HLA loci mismatched related donor (haploidentical group) The clinical outcomes of the bone marrow transplantion were compared with thase of 13 consecutive HLA identical sibling transplantion (identical group) In haploidentical donor BMT, the donors of patients were given G CSF (Lenograstim Chugai) 250 μg/day for seven doses prior to marrow harvest CSA, MTX, ATG and mycophenolate mofetil (MMF) were combined for GVHD prophylaxis ATG 5 mg/kg/day was infused for 4 days before transplantation and MMF was adminisered from 7 th day after Results All the patients were engrafted The median number of CD + 34 cells in graft was 6 1×10 6/kg in haploidentical group and 2 5×10 6/kg in identical group ( P <0 01) The median number of CD + 3 cells was 50 5×10 6/kg and 47 0×10 6/kg respectively ( P >0 05) All patients had 100% donors hematopoietic cells after transplantation by cytogenetic evidence analysis Five of the thirteen patients (38 5%) in haploidentical group and three of the thirteen patients(23 1%) in identical group experienced Ⅱ～Ⅳacute GVHD ( P >0 05) The probability of chronic GVHD was 87 5% in haploidentical group and 67 5% in identical group ( P >0 05), However none in both groups developed extensive cGVHD The median follow up duration was 453 days (range 180～690 days) for haploidentical group and 510 days (range 220～810 days) for identical group In haploidentical group, five patients died from transplant related mortality (3 GVHD, 2 infection), none relapsed and eight patients(61 5%) survive in disease free situation In identical group,two patients died from transplant related mortality (1 GVHD,1 infection),two patients died from relapse and nine patients (69 2%) survive in disease free situation DFS in haploidentical group and in identical group was similar( P >0 05) Conclusion The transplants from haploidentical donor used in this study is 3effective and feasible in preventing acute severe GVHD and improving DFS
出处
《中华内科杂志》
CAS
CSCD
北大核心
2001年第11期760-763,共4页
Chinese Journal of Internal Medicine
