亲缘间造血干细胞移植治疗恶性血液病的临床分析

Clinical analysis of related hematopoietic stem cell transplantation in the treatment of hematological malignancies

关键词:  外周血  造血干细胞移植  血液病  临床疗效

Key words:  peripheral blood  hematopoietic stem cell transplantation  hemopathy  clinical efficacy

摘要:

目的　分析亲缘间异基因外周血造血干细胞移植（Allo-PBSCT）治疗恶性血液病的相关并发症及临床疗效。方法　选取2013年10月至2018年1月华北理工大学附属医院行亲缘间Allo-PBSCT的患者60例，给予改良的BU/CY预处理，分析移植后造血重建情况及移植物抗宿主病(GVHD)、感染、出血性膀胱炎等移植相关并发症。结果　白细胞植活为13（10～22）d，血小板植活为16（12～24）d。29例（48.3%）发生GVHD，17例（28.3%）发生急性移植物抗宿主病aGVHD，12例（20.0%）发生慢个性移植物抗宿主病cGVHD；8例（13.3%）发生侵袭性真菌感染（IFI）；38例（63.3%）发生巨细胞病毒（CMV）感染；8例（13.3%）发生出血性膀胱炎。随访至2018年6月，中位生存时间为31（26～36）月，共18例（30.0%）死亡，10例（16.7%）因移植相关并发症死亡，8例（13.3%）因疾病复发死亡。3年疾病无进展生存率（PFS）及总生存率（OS）分别为62.2%和66.7%。结论　亲缘间Allo-PBSCT是治疗恶性血液病的有效方法，复发及移植相关死亡可能是影响长期生存的主要原因。

Abstract:

Objective To analyze complications and clinical efficacy of related allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in the treatment of hematological malignancies. Methods Totally, 60 patients who had related Allo-PBSCT were selected. Improved BU/CY preconditioning was performed. Post-transplantation hematopoietic reconstitution and complications such as graft versus host disease (GVHD), infection, hemorrhagic cystitis, etc. were analyzed. Results Leukocyte engraftment was 13 (10-22) d, platelet engraftment was 16 (12-24) d. Totally, 29 cases (48.3%) had GVHD, including 17 cases (28.3%) of acute GVHD (aGVHD) and 12 (20%) cases of chronic GVHD (cGVHD). Other complications included 8 cases (13.3%) of invasive fungal infection (IFI), 38 cases (63.3%) of cytomegalovirus (CMV) infection and 8 cases (13.3%) of hemorrhagic cystitis. The patients were followed up until June 2018 with a median survival time of 31（26-36）months. A total of 18 patients (30%) died, including 10 patients (16.7%) of transplant related complications and 8 patients (13.3%) of recurrence. The 3-year progression-free survival (PFS) and overall survival (OS) were 62.2% and 66.7%, respectively. Conclusion Related Allo-PBSCT is an effective way to treat hematological malignancies. Recurrence and transplant related death are the major causes affecting the long-term survival.