急性白血病半相合外周血造血干细胞移植后发生单纯肠道aGVHD的影响因素及治疗转归

摘要

Objective:To investigate the risk factors and therapeutic outcome of acute graft versus host disease (aGVHD) in patients with acute leukemia after haploidentical peripheral hematopoietic stem cell transplantation.Methods:The clinical data of 19 cases of acute leukemia underwent haploidentical hematopoietic stem cell transplanttion during January 2010 and December 2010 were retrospectively analyzed.The effects of patients sex,donor-recipient sex difference,donor age,conditioning regimen,dosage of anti-thymocyte globulin (ATG),mononuclear cell and CD34 + cell counts on the intestinal aGVHD were analyzed by Logistic regression.Results:Intestinal aGVHD occurred in 5 cases with 1 case at stage Ⅱ,3 cases at stage Ⅲ and 1 case at stage Ⅳ on the 7th,22th,27th,70th and 154th day after transplantation,respectively.Single factor analysis showed that the patient's sex,donor-recipient sex difference,donor age,dosage of ATG,mononuclear cell and CD34 + cell counts were not related with the occurrence of the intestinal aGVHD,and the conditoning regimen was the risk factor for the intestinal aGVHD.2 cases among 5 cases with intestinal aGVHD were treated with methylprednisolone at dosage of 1 mg/kg per day,1 case was treated with methylprednisolone therapy combined with tacrolimus.2 cases of methylprednisolone-resistance were treated with CD25 monoclonal antibody.Intestinal aGVHD of all patients was improved after the above-mentioned treatment.Conclusion:Conditioning regimen of haploidentical peipheral hematopoieitc stem cell transplantaion has effects on the intestinal aGVHD,which needs to be confirmed by further research.%目的:观察急性白血病半相合外周血造血干细胞移植后影响单纯肠道aGVHD发生的危险因素及治疗转归.方法:回顾性分析我院2010年1月至2016年12月期间行半相合外周血造血干细胞移植的19例急性白血病患者的临床资料,探究发生与未发生肠道aGVHD患者的临床特征差异,单因素分析患者性别、供受者性别差异、供者年龄、预处理方案、兔抗人胸腺细胞免疫球蛋白用量、回输的单个核细胞计数及CD34+细胞计数对肠道aGVHD发生的影响.观察发生肠道aGVHD患者治疗后的临床转归.结果:19例患者中5例于移植后发生肠道aGVHD(Ⅱ级1例,Ⅲ级3例,Ⅳ级1例),发生时间分别为移植后7,22,27,70和154 d.单因素分析显示,患者性别、供受者性别差异、供者年龄、兔抗人胸腺细胞免疫球蛋白用量、回输的单个核细胞计数及CD34+细胞计数与肠道aGVHD的发生无相关性,BuCy预处理方案同肠道aGVHD的发生可能相关(P＜0.05).5例患者中2例经甲强龙1 mg/(kg·d)治疗后好转,1例患者应用甲强龙联合他克莫司治疗后好转,其余2例患者对激素耐药,应用含CD25单克隆抗体的免疫抑制方案治疗后好转.结论:半相合外周血造血干细胞移植中BuCy预处理方案可能对移植后肠道aGVHD的发生有一定的影响,需要扩大病例数进一步观察确定.