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目的探讨不同类型异基因造血干细胞移植(allo-HSCT)治疗白血病的疗效、造血重建及存活情况。方法哈尔滨血液病肿瘤研究所2003年3月至2006年7月进行异基因造血干细胞移植的白血病患者20例,其中同胞间人类白细胞抗原(HLA)相合的异基因外周血造血干细胞移植(allo-PBSCT)12例,无亲缘关系HLA不全相合脐血移植(UCBT)4例,无关供者的异基因外周血干细胞移植(其中1例HLA-CW位点亚型不合)3例,无关供者骨髓移植1例(经过去除红细胞处理)。结果19/20受者获造血重建,UCBT患者造血重建速度较HLA相合的同胞allo-PBSCT慢,异基因造血干细胞移植后20例患者中发生急性移植物抗宿主病(aGVHD)7例,其中4例Ⅰ~Ⅱ度,3例Ⅲ~Ⅳ度。3例患者死于复发,3例死于移植物抗宿主病(GVHD),另15例至今仍无病存活,中位存活时间30(1~41)个月。结论allo-HSCT是目前治愈白血病的有效方法,对于无同胞HLA相合的供者,选择较高细胞数量,HLA1~2个位点不合的UCBT仍然有效、可行。
Objective To investigate the efficacy, hematopoietic reconstitution and survival of different types of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of leukemia. Methods Twenty patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation from March 2003 to July 2006 in Harbin Institute of Hematology and Oncology were enrolled. Allo-PBSCT (allo-PBSCT) ), 12 unrelated HLA-incompatible umbilical cord blood transplantation (UCBT), 4 unrelated donor allogeneic peripheral blood stem cell transplantation (including 1 HLA-CW locus subtype incompatibility), 3 unrelated donor bone marrow transplantation 1 case (after removing erythrocyte treatment). Results 19/20 recipients were hematopoietic reconstructed. The rate of hematopoietic reconstitution in UCBT patients was slower than that in HLA-matched sibs allo-PBSCT. Seven of the 20 patients with acute graft-versus-host disease (aGVHD) developed allogeneic hematopoietic stem cell transplantation, of which 4 Cases Ⅰ ~ Ⅱ degrees, 3 cases Ⅲ ~ Ⅳ degrees. Three patients died of recurrence, three died of graft-versus-host disease (GVHD), and the remaining 15 remained disease-free for the mean time to date with a median survival of 30 (1-41) months. Conclusions Allo-HSCT is an effective method for the treatment of leukemia. For those donors with no HLA matching, UCBT with higher cell number and HLA-1 to HLA-2 loci is still valid and feasible.