ABO血型不合的同胞异基因外周血干细胞移植

目的探讨HLA配型相合、ABO血型不合的同胞异基因外周血干细胞移植(alloPBSCT)的疗效。方法对27名HLA配型相合、ABO血型不合的血液恶性肿瘤患者作同胞alloPBSCT(实验组,供、受者ABO血型主侧不合的有15例,次侧不合的有10例,主次侧均不合的有2例),其中急性髓细胞白血病(AML)6例、急性淋巴细胞白血病(ALL)8例、慢性粒细胞性白血病(CMLLP)10例、骨髓增生异常综合征(MDSRAEBT)2例、非霍奇金氏淋巴瘤(ⅣB)1例;并选用同期的35名ABO血型相合的移植患者作比较(对照组)。移植物抗宿主病(GVHD)的预防采用霉酚酸酯(MMF)、环孢菌素A(CSA)和短程甲氨喋呤(MTX)三联预防方案。结果62例全部造血重建。实验组:27名alloPBSCT患者均未出现急性溶血反应,主侧不合者红系造血明显延迟,供/受者血型为A/O的患者中有3例(3/7)发生纯红细胞再生障碍性贫血(PRCA),27名患者于移植后25～153d血型成功转变为供者型;实验组GVHD发生率、VOD发生率、CMV感染、HC发生率及疾病复发率、死亡率与对照组相比差异无统计学意义(P>0.05)。结论ABO血型不合可以进行alloPBSCT,并且不影响干细胞移植的植活、GVHD及其它移植相关并发症的发生和预后。供/受者血型为A/O是主侧ABO血型不合患者alloPBSCT后PRCA发生的高危因素。

ABO-incompatible sibling allogeneic peripheral blood stem cell transplantation (allo-PBSCT)

Objective To investigate the safety and effectiveness of HLA-matched ABO-incompatible allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods Between June 2001 and June 2005, 27 patients with hematopoietic malignancies received allo-PBSCT from HLA-identical ABO-incompatible sibling donors. Among them, 15 were major ABO-incompatible, 10 minor, 2 bidirectional. Six patients suffered from acute myeloid leukemia(AML); 8 acute lymphocytic leukemia (ALL); 10 chronic myeloid leukemia (CML); 2 myelodysplasia (MDS-RAEB-T); 1 non-Hodghin's lymphoma (NHL-ⅣB). Control group included 35 HLA-matched patients who received allo-PBSCT with ABO-compatible grafts. A combination of cyclosporine (CSA), mycophenolate mofetni (MMF) and methotrexate (MTX) was administered for GVHD prophylaxis. Results Sixty two patients were successfully engrafted. Twenty seven recipients of ABO-incompatible grafts had no evidence of acute hemolysis. In major ABO-incompatible group, the onset of erythropoiesis after allo-PBSCT was delayed. Three of 7 patients with blood group "O" receiving a group "A" developed pure red cell aplasia(PRCA). The blood type of 27 patients changed to the type of donors in 61 days (25~153 days) after the transplantation. The incidences of GVHD、VOD、HC、CMV infection、disease relapse and prognosis were not difference between ABO-incompatible and ABO-compatible recipients(P>0.05).Conclusion ABO-incompatible allo-PBSCT is fairly safe if there is indication. There was no influence on engraftment, incidence of GVHD or prognosis. However, an O to A group transplantation contributes significantly to the post-transplant PRCA.