首页> 中文期刊>重庆医学 >150例异基因造血干细胞移植治疗恶性血液病的疗效分析

150例异基因造血干细胞移植治疗恶性血液病的疗效分析

     

摘要

Objective To evaluate the efficacy and safety and to analyze related complications and potential prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT ) on hematological malignancies .Methods Patients with hemato-logical malignancies who underwent allo-HSCT from June 2010 to June 2015 were investigated in this retrospective study .Accord-ing to the donor types ,it was divided into compatriots sibling-matched transplantation group (n = 52) and haploid transplantation group (n= 98) .The preconditioning regimens were busulfan/cyclophosphamide ,and anti-thymocyte globulin were needed in haploid transplantation group .Short-term methotrexate + cyclosporine A + mycophenolate mofetil were used for prevention of graft-ver-sus-host disease .The efficacy and safety and related complications of allo-HSCT were analyzed .Results All patients achieved full donor type engraftment ,which was identified by blood type ,chromosome test and DNA polymorphism .The mean times of neutro-phil and platelet engraftment were 12 d and 16 d in compatriots sibling-matched transplantation group and 13 d and 16 d in haploid transplantation group ,respectively .59 cases (39 .3% ) patients were oral mucosa ulcer ,47 patients (31 .3% ) were bacteria and/or fungal infection ,41 cases (27 .3% ) patients were CMV infection ,48 cases (32 .0% ) were acute GVHD ,43 patients (28 .7% ) were chronic GVHD .The median follow-up time of 23 months (1 - 60 months) ,115 patients (76 .7% ,115/150) were disease-free sur-vival ,including 38 cases (73 .1% ,38/52) in compatriots sibling-matched transplantation group ,77 cases (78 .6% ,77/98) in haploid transplantation group ;35 cases (23 .3% ,35/150) patients were died ,including 14 cases (26 .9% ,14/52) in compatriots sibling-matched transplantation group ,21 cases (21 .4% ,21/98) in haploid transplantation group .Death cause analysis showed that 12 ca-ses (8 .0% ) complications from transplantation related death ,of which 5 cases (3 .3% ) were severe infection ,7 cases (4 .7% ) caused by acute GVHD ,23 cases (8 .7% ) patients died because of the primary disease recurrence .The survival rate and mortality was similar between the two groups (P> 0 .05) .Conclusion Allo-HSCT is safe and effective treatment in hematological malignan-cies .The curative effect and security with haploid transplantation were similar to compatriots sibling-matched transplantation .It is necessary to prevent prognostic impact factors such as acute GVHD and infection early .%目的:分析异基因造血干细胞移植(allo-HSCT )治疗恶性血液病的疗效及安全性,探讨移植相关并发症及影响预后的因素。方法回顾性分析2010年6月至2015年6月贵州医科大学附属医院造血干细胞移植中心行 allo-HSCT 的150例恶性血液病患者的病历资料。按照供者类型不同,将其分为同胞全相合移植组(n=52)和单倍体移植组(n=98)。所有患者均采用改良白消安/环磷酰胺(BU /CY)为预处理方案,单倍体移植组加用兔抗人胸腺细胞免疫球蛋白(ATG),移植物抗宿主病(GVHD)的预防采用短疗程甲氨蝶呤+环孢素 A +吗替麦考酚酯,对150例患者疗效、安全性及移植相关并发症进行分析。结果150例患者经血型、染色体或 DNA 多态性检测证实均达到完全供者细胞植入,同胞全相合移植组平均中性粒细胞及血小板重建时间为移植后12 d 和16 d ,单倍体移植组平均中性粒细胞及血小板重建时间为移植后13 d 和16 d 。150例患者中,59例(39.3%)患者出现口腔黏膜溃疡,47例(31.3%)患者移植后100 d 内发生细菌和(或)真菌感染,41例(27.3%)患者移植后100 d 内发生巨细胞病毒感染,48例(32.0%)患者发生急性 GVHD ,43例(28.7%)患者发生慢性 GVHD 。随访1~60个月,中位随访时间23个月。115例(76.7%)患者无病存活,其中同胞全相合移植组38例(73.1%,38/52),单倍体移植组77例(78.6%,77/98)。35例(23.3%,35/150)患者死亡,其中同胞全相合移植组死亡14例(26.9%,14/52),单倍体移植组死亡21例(21.4%,21/98)。死因分析发现,12例(8.0%)因移植相关并发症死亡,其中5例(3.3%)因严重感染,7例(4.7%)因急性 GVHD ;23例(15.3%)患者因原发病复发死亡。两组患者生存率及死亡率比较差异无统计学意义(P>0.05)。结论 allo-HSCT 治疗恶性血液病安全有效,单倍体移植的疗效与安全性接近全相合移植,急性 GVHD 和感染是严重影响移植疗效和预后的危险因素,需早期预防。

著录项

  • 来源
    《重庆医学》|2016年第2期|148-150155|共4页
  • 作者单位

    贵州医科大学附属医院血液科/贵州省造血干细胞移植中心;

    贵阳 550004;

    贵州医科大学附属医院血液科/贵州省造血干细胞移植中心;

    贵阳 550004;

    贵州医科大学附属医院血液科/贵州省造血干细胞移植中心;

    贵阳 550004;

    贵州医科大学附属医院血液科/贵州省造血干细胞移植中心;

    贵阳 550004;

    贵州省安顺市人民医院血液科 561000;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 骨髓移植;
  • 关键词

    造血干细胞移植; 血液肿瘤; 手术后并发症; 治疗结果;

  • 入库时间 2022-08-18 02:00:10

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