论文部分内容阅读
目的探讨粒细胞集落刺激因子(G-CSF)动员的异基因骨髓与外周血干细胞混合移植后造血重建、移植物抗宿主病(GVHD)、复发及生存情况。方法45例血液病患者进行了动员后的异基因骨髓联合外周血干细胞混合移植,人白细胞抗原(HLA)全合37例,1~3个位点不合8例。38例恶性病中32例采用清髓性预处理,6例为减低强度预处理;7例重型再生障碍性贫血(SAA)均采用环磷酰胺联合兔抗人胸腺细胞球蛋白(ATG)及甲泼尼龙预处理。采用环孢素联合霉酚酸酯预防移植物抗宿主病,HLA不全相合患者加用ATG。供者给予G-CSF连续5天皮下注射,注射后第5天采集外周血干细胞,第7天采取骨髓血。结果45例患者均获得快速造血重建,中性粒细胞绝对计数≥0.5×109/L,血小板≥20×109/L的中位时间分别为移植后的12(8~18)天和16(10~28)天。10例发生了急性GVHD(22%),Ⅱ度以上1例。可评估的42例患者中16例出现了慢性GVHD,7例为广泛型(16%)。复发9例,死亡11例,其余34例中位随访时间16月(10~46月),可评估的2年无病生存率为75%。结论G-CSF动员后的异基因骨髓联合外周血干细胞移植治疗血液病可获快速造血重建,移植相关死亡率及重度急、慢性GVHD的发生率低,复发率不增高。
Objective To investigate the hematopoietic reconstitution, graft-versus-host-disease (GVHD), relapse and survival in allogeneic bone marrow mixed with peripheral blood stem cells mobilized by granulocyte-colony stimulating factor (G-CSF) Methods Forty - five patients with hematological diseases underwent combined mobilization of allogeneic bone marrow combined with peripheral blood stem cell transplantation. HLA - A combined with HLA - A combined in 37 cases, 1 to 3 sites in 8 cases. Thirty-eight cases of malignant disease were treated with myeloablative preconditioning and six with pretreatment of decreasing intensity. Seven cases of severe aplastic anemia (SAA) were treated with cyclophosphamide combined with rabbit anti-human thymocyte globulin (ATG) Prednisolone pretreatment. Cyclosporin combined with mycophenolate mofetil to prevent graft-versus-host disease, HLA-incompatibility patients with ATG. The donor gave G-CSF subcutaneously for 5 consecutive days. Peripheral blood stem cells were collected on the 5th day after injection and bone marrow blood was taken on the 7th day. Results All the 45 patients achieved rapid hematopoietic reconstitution. The median neutrophil count ≥0.5 × 109 / L and platelet ≥20 × 109 / L were 12 (8-18) and 16 ~ 28) days. Acute GVHD occurred in 10 cases (22%) and in 1 case of grade II. Of the 42 evaluable patients, 16 developed chronic GVHD and 7 were extensive (16%). There were 9 recurrent cases and 11 deaths. The remaining 34 patients were followed up for a median of 16 months (range, 10 to 46 months). The 2-year disease-free survival rate was 75%. Conclusion Allogeneic bone marrow combined with peripheral blood stem cell transplantation after G-CSF mobilization can hematopoietic reconstructive therapy for hematological diseases. The incidence of graft-related mortality and severe acute and chronic GVHD is low and the recurrence rate is not increased.