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目的探讨亲缘性HLA半相合造血干细胞移植(Hi-HSCT)治疗高危或难治性急性白血病的临床疗效及安全性。方法回顾性分析2009年12月至2013年10月在解放军第三〇九总医院接受Hi-HSCT治疗高危或难治性急性白血病患者23例患者临床资料。移植预处理采用改良BUCY(白舒非+环磷酰胺)或CY/TBI(环磷酰胺/全身放疗)方案,急性移植物抗宿主病(aGVHD)预防方案采用抗胸腺细胞球蛋白(ATG)、环孢菌素、甲氨蝶呤及霉酚酸酯,肝静脉闭塞病(VOD)预防采用前列腺素E联合低分子肝素、复方甘草酸苷。两组患者GVHD发生率比较用c2检验,造血重建时间比较用t检验,两组患者生存分析采用Kaplan-Meier生存曲线方法。结果 28例均获造血重建。3年无病生存率(DFS)及总生存率(OS)分别为52﹪和57﹪。Ⅰ~Ⅱ度与Ⅲ~Ⅳ度aGVHD发生率分别为35﹪和12.5﹪,无一例中重度VOD发生。移植相关死亡(TRM)12例,其中8例(67﹪)死于疾病复发,移植时疾病状态为CR1组患者复发死亡率(16﹪),显著低于CR2与复发组(63﹪)(P=0.03)。结论对于无同胞相合的中、高危急性白血病患者,通过改良预处理方案及恰当的GVHD预防措施可获得较高移植成功率,选择合适的移植时机及恰当的支持治疗可显著提高Hi-HSCT移植疗效。
Objective To investigate the clinical efficacy and safety of relative HLA haploidentical hematopoietic stem cell transplantation (Hi-HSCT) in the treatment of high-risk or refractory acute leukemia. Methods The clinical data of 23 patients with high-risk or refractory acute leukemia treated with Hi-HSCT at the 309 rd People’s Liberation Army General Hospital from December 2009 to October 2013 were retrospectively analyzed. Transplantation pretreatment with anti-thymocyte globulin (ATG), anti-thymocyte globulin (aGVHD) and anti-thymocyte globulin (aGVHD) Cyclosporine, methotrexate and mycophenolate mofetil and hepatic veno-occlusive disease (VOD) prevention using prostaglandin E combined with low molecular weight heparin and compound glycyrrhizin. Two groups of patients with GVHD incidence using c2 test, hematopoietic reconstruction time t test, survival analysis of two groups using Kaplan-Meier survival curve method. Results 28 cases were reconstructed by hematopoiesis. Three-year disease-free survival (DFS) and overall survival (OS) were 52% and 57%, respectively. The incidence of grade Ⅰ ~ Ⅱ and grade Ⅲ ~ Ⅳ aGVHD were 35% and 12.5%, respectively, and no case of moderate or severe VOD occurred. Twelve patients (TRM) died of graft-related death (TRM), of which 8 (67%) died of disease recurrence. The disease status was CR1 mortality (16%), significantly lower than CR2 and recurrences = 0.03). Conclusion For patients with moderate to high risk of acute myeloid incompatibility, higher success rate of transplantation can be obtained by improving the preconditioning regimen and proper GVHD prophylaxis. Choosing the appropriate timing of transplantation and appropriate supportive care can significantly improve the efficacy of Hi-HSCT transplantation .