摘要
目的探讨含/不含全身照射(TBI)作为预处理方案在自体外周血干细胞移植(APBSCT)治疗自身免疫性疾病中的造血重建、免疫重建、疗效和并发症等方面的差异。方法自1999—2006年6月,共有32例严重的自身免疫性疾病患者接受了 APBSCT。其中女性27例、男性5例,中位年龄29岁(15～49岁)。所有患者均采用环磷酰胺(CTX)+粒细胞集落刺激因子(rhG-CSF)方案动员,采集物均应用 CliniMACS 细胞分选仪分选 CD34^+细胞。21例患者预处理方案采用CTX+TBI,11例采用 CTX+抗胸腺细胞球蛋白(ATG)。结果两组的造血重建 CTX+TBI 组粒细胞植入中位时间为11 d,CTX+ATG 组为9 d,组间比较差异有统计学意义(P=0.003),两组血小板植入的中位时间分别为13 d 和8 d,组间比较,P=0.001;移植后12个月时两组患者淋巴细胞各亚群均已恢复,但 CD4/CD8比值仍倒置,各亚群水平两组间差异均无统计学意义;所有患者随访12个月以上,CTX+TBI 组有3例(14.3%)复发,CTX+ATG 组有2例(18.2%)复发,其余患者病情稳定;移植期间 CTX+TBI 组细菌感染发生率为5/21(23.8%),病毒感染1例(4.8%),放射性腮腺炎4/21(19%),CTX+ATG 组细菌感染发生率为2/11(18.2%),病毒感染2例(18.2%),血清病反应3/12(25%)。两组患者感染均在抗生素或抗病毒治疗后很快得到控制,均无因血小板减少引起致命的出血并发症。两组患者在随访时间内均未出现肺间质纤维化、白内障等远期并发症。结论含 TBI 的预处理方案在造血重建上迟于不含 TBI 的方案,但 CTX+TBI 的耐受性好,疗效上两者无明显差异,在免疫重建方面差别不明显。
Objective To investigate the differences in immune reconstitution, hematopoietic reeonstitution, efficacy, and complication between the two conditioning regimens with or without total body irradiation （TBI） in patients with refractory and severe autoimmune diseases （AID） who receiving autologous peripheral blood stem cell transplantation （APBSCT）. Methods Thirty-two AID patients, 5 males and 27 females, aged 29 （15-49）, underwent APBSCT. The CD34^＋ cells were mobilized with eytoxan （CTX） ＋ granulocyte-colony stimulating factor （G-CSF） and selected by clinical magnetic activated cell sorting （CliniMACS）. The conditioning regimen included CTX ＋ antithymocyte globulin （ATG） in 11 patients and CTX ＋TBI in 21 patients. All the patients were followed up for more than 12 months. Results The median time of granulocyte recovery were 11 and 9 days in the CTX ＋ TB! and CTX ＋ ATG groups respectively （P = 0. 003 ）, the median time of platelet recovery were 13 and 8 days respectively （ P = 0. 001 ）. In both groups, the lymphocyte subsets were recovered with the inverted CD4/CD8 ratio 12 months after transplantation. Relapse was seen in 3 cases of the CTX ＋ TBI group （ 14.3% ）, and 2 cases of the CTX ＋ ATG group （18.2%） ,and the rest of patients remained free of AID. During transplantation incidence of bacteria infection occurred in 5 of the 21 cases in the CTX ＋ TBI group （23.8%） and in 2 of the 11 cases of the CTX ＋ ATG group （ 18.2% ） respectively; viral infection occurred in 1 of the 21 cases of the CTX ＋ TBI group （4.8%） and in 2 of the 11 cases of the CTX ＋ ATG group （ 18.2% ） respectively. The number of radiated parotitis was 4 among the 21 patients of the CTX ＋ TBI group（ 19% ）and was 3 among the 12 patients of the CTX ＋ ATG group（25% ）. Serum sickness reaction occurred in 3 of the 12 patients of the CTX ＋ ATG group （ 25% ）. Bacterial and viral infections were cured soon after antibacterial or antiviral therapy, no fatal bleeding occurred due to thrombocytopenia in both groups. Conduslon The conditioning regimen of TBI ＋ CTX delays the hematopoietic reconstitution compared with the ATG ＋ CTX regimen in treating AID. The regimen of CTX ＋ TBI can be better tolerated, but there are no significant differences in efficacy and immune reconstitution among these two regimens.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第24期1689-1692,共4页
National Medical Journal of China
关键词
造血干细胞移植
移植
自体
移植预处理
自身免疫疾病
Hematopoietic stem cell transplantation
Transplantation, autologous
Transplantation conditioning
Autoimmune diseases
