摘要
目的比较非血缘关系骨髓（UBMT）及外周造血干细胞移植（UPBSCT）在移植疗效方面的差异。方法63例患者分为UBMT组30例，UPBSCT组33例。两组均采用本所的加强方案预防移植物抗宿主病（GVHD）的发生。所有患者在预处理阶段都应用了抗T细胞免疫球蛋白（ATG）或CD，单抗，但UPBSCT组以兔源性的ATG为主（21／33），而UBMT组以猪源性的ATG为主（17／25，P=0．02）。结果UBMT和UPBSCT组分别有28／30例和32／33例患者达到完全稳定的供者植入，UBMT组输入单个核细胞中位数（2．80×10^8／kg）少于UPBSCT组（6．16×10^8／kg，P〈0．05），WBC和PLT的中位植活时间长于UPBSCT组（17d比11d；27．5d比14d，P〈0．01）。两组≥Ⅱ度急性GVHD的累积发生率分别为66．7％和33．0％；其中Ⅲ-Ⅳ度为34．5％和7．3％（P〈0．05）。在对两组ATG的来源进行分层分析后发现急性GVHD的发生率没有统计差异。两组慢性GVHD的发生率分别为63．6％（14／22）、72．0％（18／25），其中广泛型分别为7例和5例，差异无统计学意义（P〉0．05）。UBMT和UPBSCT组巨细胞病毒（CMV）血症和CMV疾病的发生率分别为60．0％（18／30）、43．3％（13／30）；60．6％（20／33）、15．1％（5／33）。截至2005年6月，UBMT复发4例，死亡15例，总体生存率（OS）为47．22％，UPBSCT组复发6例，死亡8例，OS为62．45％。1年的总生存率分别为53．13％、78．06％（P=0．05），总的移植相关病死率分别为51．52％、19．68％（P=0．06）。结论UPBSCT同骨髓移植相比，造血重建快，并不增加急性GYHD的发生，两组生存率相近。
Objective To compare the outcomes in hematological patients receiving unrelated peripheral blood stem cell transplants （UPBSCT） with those receiving unrelated bone marrow transplants （UBMT） in a retrospective analysis. Methods Sixty-three patients with hematological diseases with HLA- matched （65%） or mismatched （35%） unrelated donors were receiving UPBSCT （n =33） or UBMT （n = 30） between May 2001 and June 2005 in our institute. They all received standard conditioning regimens with Bu/Cy（ n = 53 ） or TBI/Cy （ n = 10 ） with the addition of ATG for 3-4 days （ n = 58 ） or CD3 antibody （ n = 5 ）. There were more patients receiving rabbit ATG in the UPBSCT group than UBMT （21/33 vs 8/25, P=0. 02） and the remaining patients received pig ATG. Graft versus host disease（GVHD） prophylaxis consisting of cyclosporine, methotrexate and mycophenolate mofetil were the same. Results The two groups were matched for the following factors：gender, diagnosis, HLA-compatibility and conditioning regimens. The median age in the UPBSCT group was 29. 5（ 10-47）years and in the UBMT 21.5（7-42） years（P 〈0. 05 ）. The UPBSCT group consisted of 10 females and 23 males and the UBMT group 7 females and 23 males. Eleven patients in the UPBSCT and 8 patients in the UBMT group were diagnosed with as chronic myeloid leukemia（CML） ; 9 and 12 as acute myelocytic leukemia（ AML）; 11 and 10 as acute lymphatic leukemia （ALL）; 2 and 0 as severe aplastic anemia（SAA）. There were more patients in aggressive stage （ 〉 CR1 ） in the UBMT group than in the UPBSCT group （9/30 vs 3/33, P =0. 06）. Median follow-up was 12 months after UPBSCT and 20 months after UBMT （ P 〈 0. 05 ）. UPBSCT group had a higher number of infused MNC as comparison with UBMT group （6. 16 × 10^8/kg vs 2. 80 × 10^8/kg, P 〈0. 05）. Both neutrophil and platelet recovery were faster after UPBSCT （11 days vs 17 days, 14 days vs 27.5 days, P 〈0. 01 ）. Although the cumulative incidence of grades Ⅱ-Ⅳacute GVHD and severe aGVHD in the UPBSCT group were less than in the UBMT group （ 33.04% vs 66. 69%, 7.26% vs 34. 52%, P 〈 0. 05 ）, there was no difference after the source of ATG was counted. The incidence of chronic GVHD did not differ between the two groups （ 18/ 25 vs 14/22）. Relapse including molecular relapse occurred in 6 of the 31 patients after UPBSCT and in 4 of the 30 patients after UBMT （P 〉0. 05）. Finally, fifteen of the 30 patients died after UBMT, as compared with 8 of the 33 patients after UPBSCT. The cumulative overall survival was 62. 45% after UPBSCT and 47.22% after UBMT （ P = 0. 114）. Conclusion Our results indicate that UPBSCT led to significantly faster leukocyte and platelet engraftment without increasing the incidence of aGVHD and the overall survival was comparable between the two methods of therapy.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2006年第8期624-627,共4页
Chinese Journal of Internal Medicine
关键词
造血干细胞移植
移植物抗宿主病
巨细胞病毒感染
Hematopoietic stem cell transplant
Graft versus host disease
Cytomegalovirus infections
