摘要
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 treatmnent of graft-versus-host disease（GVHD） for the allogeneic hematopoietic stem cell transplantation（allo-HSCT）. Methods Fifty-five patients,included 30 CML patients,12 AML patients,11 ALL patients and 2 MAL patients,were treated with allo-HSCT. 48 patients received related donor hematopoietic stem cell transplantation（RD-HSCT） Among them,45 had HLA genotypes and 3 had mismatch for 1 or 3 genetic locus. Another 7 patients all genotypically matched underwent unrelated donor hematopoietic stem cell transplantation（URD-HSCT）. Forty-three patients received CsA＋MTX＋MMF protocal for GVHD prophylaxis and additional ATG was used for another 12 patients. Results All the patients engrafted were acquired hematopoietic reconstruction. 12 （21. 1%） patients got Ⅰ -- Ⅱ aGVHD, 11 （20%） patients got cGVHD,local cGVHD occurred in 8 patients and extensive cGVHD in 3. Acute GVHD and extensive chronic GVHD could be controlled by high dose MP. Conclusion For the HLA-matched related donor hematopoietic stem cell transplantation,CsA＋ MTX＋ MMF can prevent aGVHD effectively,and in HLA-mismatched relative hematopoietic stem cell transplantation and URD-HSCT, the above 3 drugs in combination with ATG can decrease the incidence and severity of aGVHD.
出处
《重庆医学》
CAS
CSCD
2007年第17期1722-1724,共3页
Chongqing medicine
基金
重庆市医学重点学科建设基金资助项目(2006C028)
第三军医大学新桥医院"1520人才培养工程"基金资助项目(2006)。
