非清髓性异基因造血干细胞移植治疗恶性血液病26例.doc

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1、非清髓性异基因造血干细胞移植治疗恶性血液病26例作者：苏丽萍，许莲蓉，姜波，叶芳，朱秋娟，鹿育晋,崔月娥，朱镭，张丽，马香兰【摘要】为研究非清髓性异基因造血干细胞移植(non-myeloablativeal1ogeneicstemcel1transplantation,allo-NST)治疗恶性血液病的疗效及相关技术，选择26例恶性血液病患者作为研究对象(急性白血病10例，慢性髓性白血病14例，多发性骨髓瘤2例)，其中14例采用FAC(fludarabin+ATG+Cy)预处理，12例釆用MAC(melfalan/maleran+ATG+Cy)预处理；用G-CSF600ng/d或G-CSF

2、300ug/d+GM-CSF300ug/d进行外周血干细胞动员，于第5天开始用CobeSpectra1111细胞分离机连续釆集2-3次；用环砲菌素A联合短程甲氨蝶吟预防GVHD；移植后第4周开始供体淋巴细胞输注，首剂1X107/kg,之后依据临床反应及嵌合体形成情况，每4周1次,剂量逐级递增；微卫星短串联重复序列(STR)分析、Bcr/Abl融合基因、Ph染色体、HM位点分析、性染色体及AB0血型等为植活检测指标。结果显示：植入率84.62%,aGVHD发生率11.54%,cGVHD发生率23.07%；感染和出血等毒副反应发生率低、反应轻。结论：非清髓性异基因造血干细胞移植治疗恶性血液病疗

3、效确切，毒副作用小，但相关技术，如适应症的选择、预处理方案、移植过程中的免疫治疗等需耍进一步深入研究。【关键词】造血干细胞移植；非清髓性异基因造血干细胞移植；恶性血液病NonmyeloablativeAl1ogeneicHematopoieticStemcel1Transplantationin26CasesofHematologicalMaligna.nciesAbstractThepurposeofthisstudywastoinvestigatetheefficacyofnon-myeloab1ativeallogeneicstemcelltransplantation(allo-N

4、ST)anditsrelatedtechnologiesinhematologicalmalignancies.26patientswithhematologicalmalignancies(acuteleukemialO,chronicmyeloidleukemiald,multipiemyeloma2)receivedal1o-NSTfol1owingconditioningregimenswithfludarabin/cyclophosphamide/ATGinl4casesorbusulfanorme1phalan/cyclophosphamide/ATGinl2casesprio

5、rtoinfusionof2or3collectionsofG-CSF(600ug/d)orG-CSF(300ug/d)plusGM-CSF(300ug/cl)mobi1izedbloodstemcellonthefifthday.AcombinationofcyclosporineA(CsA)andmethotrexate(MTX)wasadministeredforGVHDprophylaxis・Patientswereeligiblefordonorlymphocyteinfusion(DLI)(ordonorstemcel1infusion(DST))giveningradedin

6、crementsaccordingtothechimericformationandclinicalfeature・Generally,thedoseofthefirstinfusionwaslX107/kgin4thweekpost-tra.nsplantation.Theengraftmentanalysesincludedthedetectionofmicrosstelliteshorttandemrepeats(STRs),bcr/ablfusiongene,Phi1adelphiachromosome,HLA-1ocusanalysis,sexchromosomeandABObl

7、oodtypeorbloodsubtype・Theresultsshowedthatoutof26patients,22(84・62%)wereengrafted,18/22werefulldonorchimerism(FDC)uptonow.AcuteGVHDoccurredin3/26(11.54%),whi1echronicGVHDwasdiagnosedin6outof26(23・07%)patients・The