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目的探讨同胞相合异基因造血干细胞移植治疗恶性血液病的临床疗效。方法将26例恶性血液病患者按移植前疾病状态分为2组:高危组11例和标危组15例。2组患者均采用外周血同胞相合异基因造血干细胞移植。预处理方案:高危组采用全身照射+环磷酰胺,标危组采用白消安+环磷酰胺;移植物抗宿主病的预防:2组均采用环孢素A+短程甲氨蝶呤,或加霉酚酸脂。观察2组患者造血重建和急、慢性移植物抗宿主病、巨细胞病毒活动性感染/巨细胞病毒病、移植复发及移植相关死亡及无病生存等情况。结果 2组患者移植后均获得造血重建,均为完全供体嵌合型。2组患者移植后14例发生急性移植物抗宿主病(aGVHD),累积发病率为53.8%(14/26)。9例发生慢性移植物抗宿主病(cGVHD),累积发病率为45.0%(9/20)。2组患者移植后有20例(76.9%)出现巨细胞病毒血症,无一例患者发生巨细胞病毒病。标危组复发率与高危组比较差异无统计学意义(6.7%vs 18.2%,P>0.05)。标危组移植相关病死率与高危组比较差异有统计学意义(13.3%vs 54.5%,P<0.05)。高危组和标危组患者1、3年累积无病生存率分别为30.3%、85.1%和15.2%、68.1%(均P<0.05)。结论移植前疾病状态是影响移植疗效的重要因素,移植物抗宿主病的发生对移植后疾病的复发及生活质量有重要的影响。
Objective To investigate the clinical efficacy of sibling allogeneic hematopoietic stem cell transplantation in the treatment of hematologic malignancies. Methods Twenty-six patients with hematologic malignancies were divided into two groups according to pre-transplant disease status: 11 in high risk group and 15 in standard risk group. 2 patients were peripheral blood sibling allogeneic hematopoietic stem cell transplantation. Pretreatment programs: high-risk group using systemic irradiation + cyclophosphamide, standard risk group with busulfan + cyclophosphamide; graft-versus-host disease prevention: two groups were treated with cyclosporine A + short-range methotrexate, or Mycophenolic acid. The hematopoietic reconstitution and acute and chronic graft-versus-host disease, cytomegalovirus active infection / cytomegalovirus disease, transplant-related recurrence, graft-related death and disease-free survival were observed in two groups. Results Both groups received hematopoietic reconstitution after transplantation, and all were completely donor chimerism. Acute graft versus-host disease (aGVHD) occurred in 14 of the 2 patients after transplantation, with a cumulative incidence of 53.8% (14/26). Nine patients developed chronic graft versus host disease (cGVHD) with a cumulative incidence of 45.0% (9/20). Twenty patients (76.9%) developed cytomegalovirus after transplantation in the 2 groups, and none of the patients developed cytomegalovirus disease. There was no significant difference in relapse rate between standard risk group and high risk group (6.7% vs 18.2%, P> 0.05). Compared with the high-risk group, the mortality of the standard-risk group was significantly different (13.3% vs 54.5%, P <0.05). The 1, 3-year cumulative disease-free survival rates of high-risk group and standard-risk group were 30.3%, 85.1% and 15.2%, 68.1% respectively (all P <0.05). Conclusion Preimplantation disease status is an important factor affecting the curative effect of transplantation. The occurrence of graft-versus-host disease has a significant impact on the recurrence of disease and quality of life after transplantation.