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目的 :采用新方法进行非体外去除T细胞的人类白细胞抗原 (humanleukocyteantigen ,HLA)配型不合造血干细胞移植。方法 :5 8例血液恶性肿瘤患者 ,33例为高危或难治复发白血病 ,接受了至少一个HLA位点不合的家庭供者造血干细胞移植。移植物为经粒细胞集落刺激因子 (granulocyteclony stimulatingfactor ,G CSF)动员的骨髓以及外周血造血干细胞 ,而无需体外去除T细胞。移植物抗宿主病 (graft versus host disease,GVHD)预防采用环孢菌素A +霉酚酸酯 +短程甲氨喋呤方案。结果 :所有患者均获得持久、完全供者植入。 5 8例患者中发生Ⅱ度及以上急性GVHD 2 2例 (37.9% ) ,其中Ⅲ度和Ⅳ度急性GVHD分别为 2例和 1例 ,其严重程度与HLA不合程度无相关 ;4 2例可评估患者中 ,慢性GVHD为 2 6例 (6 1.9% ) ,广泛型和局限型分别为 11例和 15例。复发 9例 ,除 1例外均为复发、难治白血病患者。死亡 14例 ,其中 7例死于疾病复发 ,另 7例死于移植相关合并症 ,其中严重感染和间质性肺炎各 2例 ,巨细胞病毒性脑炎、病毒型肝炎和急性GVHD死亡各 1例。中位随访 10月 (2～ 37.5月 ) ,5 8例患者中 4 2例无病存活 (disease freesurvival,DFS) ,高危患者 2年DFS明显低于标危患者 ,分别为 6 3.2 %和 77.6 % (P =0 .0 4 )。DFS与供受?
OBJECTIVE: To adopt a new method for human leukocyte antigen (HLA) non-ex vivo T cell depletion of hematopoietic stem cell transplantation. METHODS: Fifty-eight patients with hematological malignancies and 33 with high-risk or refractory relapsed leukemia underwent donor hematopoietic stem cell transplantation in at least one HLA-matched family donation. Grafts are bone marrow mobilized by granulocyte colony stimulating factor (G CSF) and peripheral blood hematopoietic stem cells without the need for in vitro T cell depletion. Graft versus host disease (GVHD) prophylaxis with cyclosporine A + mycophenolate mometamonate program. Results: All patients received a long-term, complete donor implant. Fifty-eight patients had acute GVHD Ⅱ degree and above (2 cases and 37.9%), of which grade Ⅲ and Ⅳ acute GVHD were 2 cases and 1 case respectively, the severity of which was unrelated to HLA incompatibility; 42 cases Of the patients evaluated, 26 (6.6%) had chronic GVHD and 11 (11%) had extensive and localized disease. Recurrence in 9 cases, with the exception of one exception are relapsed, refractory leukemia patients. 14 died, of which 7 died of disease recurrence and the other 7 died of transplantation-related complications, including 2 cases of severe infection and interstitial pneumonia, 1 case of cytomegalovirus encephalitis, viral hepatitis and acute GVHD respectively example. During the median follow-up period of 2 months to 37.5 months, 42 cases of disease freesurvival (DFS) were found in 58 patients, and the 2-year DFS of high-risk patients was significantly lower than that of standard patients (6.32% vs 77.6%, respectively) (P = 0 .0 4). DFS and suffer?