亲缘间HLA半相合外周血造血干细胞移植治疗急性白血病临床探究.docVIP

亲缘间HLA半相合外周血造血干细胞移植治疗急性白血病临床探究 　 作者：李栋梁，王志伟，郭晓，王友君，侯兰芬，孙宇，郭宏谋，李文静 【摘要】 　　目的 探讨HLA半相合外周血造血干细胞移植（PBSCT）治疗急性白血病的疗效及安全性。方法 4例急性白血病患者行HLA不全相合PBSCT，其中急性淋巴细胞白血病 2例,急性非淋巴细胞白血病M4b 1例、M4EO 1例，移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例,3个位点不合2例。预处理方案由全身照射或白消胺、阿糖胞苷、环磷酰胺、司莫司汀组成。移植物抗宿主病(GVHD)的预防采用环胞素A、甲氨蝶呤、霉酚酸酯、抗胸腺细胞球蛋白四联方案。结果 患者移植过程顺利,4例患者均获得造血功能重建并达完全供者植入。3例出现Ⅰ度急性GVHD ，1例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎，2例并发真菌肺炎。至今2例患者分别无病存活30月和15月，1例目前为移植后4月，1例死亡。结论 HLA半相合PB 【关键词】 白血病；HLA；半相合；干细胞移植；移植物抗宿主病 　　Abstract： Objective To explore the efficiency and safety of HLA partially mismatched peripheral blood stem cell transplantation (PBSCT) for treatment of acute leukemia.Methods Four patients with acute leukemia in complete remission, including two with acute lymphocytic leukemia and two with acute nonlymphocytic leukemiaM4, were treated by HLA partially mismatched PBSCT. Of the four patients, one was HLA1 locus mismatched, one HLA2 locus mismatched and the other two with HLA3 locus mismatched. Preconditioning regimen consisted of total body irradiation or administration of busulfan, Arac, cyclophosphamide and MeCCNU. Cytosporin A, methotrexate, mycophemolate mofetil and antithymus globulin were used to prevent graft versus host disease (GVHD).Results The transplantation was successful in all the four patients who obtained hematopoietic reconstiution and full donortype engraftment. Grade I acute GVHD (aGVHD) occurred in three patients and grade II aGVHD occurred in one patients. Two patients suffered from interstitial fungal pneumonia, and another one suffered from interstitial cytomegalovirus pneumonia. At present, three patients were alive and diseasefree for 30, 15 and 4 months respectively, and one patient died.Conclusion HLA partially mismatched PBSCT is an effective and safe therapy for acute leukemia. It can provide a new method for the treatment of leukemia patients who have no related matched donors. 　　Key words： leukemia; HLA; partial mismatch; hematopoietic stem cell transplantation; graft ve