非去T细胞单倍型相合的造血干细胞移植31例临床分析

目的 探讨HLA单倍型相合造血干细胞移植（HSCT）对恶性血液病的疗效及其预后。方法 总结2002年7月至2006年7月在我院治疗的31例恶性血液病患者（标危组11例,高危组20例）接受HLA单倍型相合HSCT临床资料,分析急性移植物抗宿主病（aGVHD）发生及其相关因素。结果 31例患者中30例获得稳定的造血重建,移植后中性粒细胞〉0．5×10^9／L及血小板〉20×10^9／L的中位时间分别为13d和22d,发生Ⅱ-Ⅳ度aGVHD的累积发生率为61．3％,慢性GVHD的累积发生率为41．9％。标危组33个月累积无病生存率（DFS）为62．3％,高危组33个月的DFS为35．0％。移植物中CD3^＋T细胞数量和供受体HLA—A、B、DR位点不相合的程度是影响aGVHD发生的主要因素。结论 HLA单倍型相合的HSCT对于恶性血液病是一种有效的治疗方法,移植物中CD3^＋T细胞数量和HLA—A、B、DR位点不相合的程度是影响单倍型相合的HSCT的aGVHD发生的主要因素。

A clinical study of 31 patients with malignant hematopoietic disease treated with non-T cell-depleted HLA-haploidentical hematopoietic stem cell transplantation

OBJECTIVE: To investigate the effects and prognosis of malignant hematological disease after HLA haploidentical hematopoietic stem cell transplantation (H-HSCT) without T-cell depletion. METHODS: The clinical data of 31 cases with malignant hemopoietic disease treated with H-HSCT from July 2002 to July 2006 were analyzed, including 11 cases of standard risk and 20 of high risk. RESULTS: 30 patients achieved engraftment of a median of 13 and 22 days for neutrophil and platelet, with an accumulative incidence of II - IV grade acute graft-versus-host disease (GVHD) 61.3%, and an accumulative incidence of chronic GVHD 41.9%. 13 patients survived with Karnofsky scale over 90.0% after a median follow-up of 24 months. 33 months of accumulative survival was 62.3% in the standard risk group and 35.0% in the high risk group. The CD(3)(+) T cells count of the graft and the disparity of HLA-A, B, DR loci were the major factors of impact on acute GVHD. CONCLUSION: HLA H-HSCT is an effective therapeutic method for malignant hematological disease, CD(3)(+) T cells count of the graft and the disparity of HLA-A, B, DR loci are the major factors of impact on acute GVHD.