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目的探索异基因造血干细胞GVHD的有效防治方法。方法异基因移植患者55例,慢性粒细胞白血病(CML)30例,急性髓系白血病(ALM)12例,急性淋巴细胞白血病(ALL)11例,急性混合细胞白血病(MAL)2例。同胞间人类白细胞抗原(HLA)全相合移植45例,非血缘异基因移植7例,HLA半相合移植3例。43例患者采用MMF、CsA联合短程MTX方案。12例患者采用MMF、CsA、短程MTX联合ATG方案。结果所有患者造血均顺利重建,12例(21.1%)发生Ⅰ~Ⅱ度aGVHD;11例(20%)发生cGVHD,局限型8例,广泛型3例。aGVHD和广泛型cGVHD经甲强龙冲击治疗后均得到控制。结论MMF、CsA、MTX、ATG三联方案能有效控制同胞间HLA全相合移植的aGVHD,加用ATG能理想的预防同胞间HLA半相合移植和非血缘异基因移植aGVHD的发生。
Objective To explore the effective prevention and treatment of GVHD in allogeneic hematopoietic stem cells. Methods 55 cases of allogeneic transplantation, 30 cases of chronic myeloid leukemia (CML), 12 cases of acute myeloid leukemia (ALM), 11 cases of acute lymphoblastic leukemia (ALL) and 2 cases of acute mixed cell leukemia (MAL). Forty-five cases of sibling human leukocyte antigen (HLA) were completely matched, 7 cases of allogeneic allograft and 3 cases of HLA haploidentical transplantation. Forty-three patients underwent MMF and CsA combined with short-course MTX. Twelve patients were treated with MMF, CsA, short-term MTX and ATG. Results All patients were successfully reconstructed with hematopoietic stem cells. Grade Ⅰ ~ Ⅱ aGVHD occurred in 12 patients (21.1%) and cGVHD occurred in 11 patients (20%). There were 8 localized cases and 3 extensive cases. Both aGVHD and extensive cGVHD were controlled by methylprednisolone. Conclusions MMF, CsA, MTX and ATG triple regimens can effectively control aGVHD with sibling allograft in siblings. Combined with ATG, they can be a good way to prevent the occurrence of aGVHD in sibling HLA haploidentical and non-HLA allograft.