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背景:由于移植技术的提高,供受者ABO血型不合已不再是异基因造血干细胞移植的障碍,但是由于宿主血凝素抗体的持续存在,ABO血型不合异基因造血干细胞移植后常出现红细胞系统恢复的延迟。目的:观察ABO血型不合异基因造血干细胞移植患者红细胞系统恢复情况,评价血型不合、人类白细胞抗原配型不相合对造血功能重建的影响。设计:回顾性分析。单位:南京大学医学院附属鼓楼医院血液科。对象:选择2002-05/2007-09在南京大学医学院附属鼓楼医院血液科行ABO血型不合异基因造血干细胞移植的恶性血液患者(受者)14例,男11例,女3例;年龄15~60岁。14例患者中7例供受者人类白细胞抗原配型完全相合,7例供受者人类白细胞抗原配型半相合。纳入同期ABO血型相合的造血干细胞移植患者11例为对照。受者在接受异基因造血干细胞移植前签署移植同意书,供者为同胞姊妹、胞弟、儿子、母亲,均同意提供用于移植的骨髓。实验经医院伦理委员会批准。方法:①预处理方案:人类白细胞抗原配型全相合组采取马利兰和环磷酰胺为主的方案。人类白细胞抗原配型半不合组采用北京人民医院的GIAC方案。②造血干细胞输注:沉降供者骨髓,取上层有核细胞输给受者。主要观察指标:观察ABO血型不合异基因造血干细胞移植的副反应、并发症及造血重建情况。结果:14例ABO血型不合患者仅1例发生单纯红细胞再生障碍性贫血未进入结果分析。①造血功能重建情况:与对照组比较,ABO血型不合组血红蛋白恢复时间明显延迟(t=2.352,P<0.05),ABO血型相同与ABO血型不合组中性粒细胞和血小板恢复情况差异无显著性意义(P>0.05)。ABO血型不合的人类白细胞抗原配型半不合造血干细胞组血红蛋白恢复和血型转换时间迟于全相合,但其差异无显著性意义(P>0.05)。②并发症:14例ABO血型不合患者移植后成分输血过程未出现溶血反应,移植后也均未发生迟发性溶血反应。结论:ABO血型不合不影响造血干细胞移植的效果,且较为安全。
BACKGROUND: Due to the improvement of transplants, donor ABO incompatibility is no longer an obstacle to allogeneic hematopoietic stem cell transplantation. However, due to persistence of host hemagglutinin antibodies, erythrocyte system often appears after ABO incompatible allogeneic hematopoietic stem cell transplantation Recovery delay. OBJECTIVE: To observe the recovery of erythrocyte system in patients with ABO-incompatible allogeneic hematopoietic stem cell transplantation and to evaluate the effect of mismatch of blood group and mismatch of human leukocyte antigen on hematopoietic reconstitution. Design: Retrospective analysis. Unit: Department of Hematology, Drum Tower Hospital Affiliated to Nanjing University Medical College. PARTICIPANTS: A total of 14 patients (11 males and 3 females) with malignant hematological malignancies (recipients) who underwent ABO-incompatible allogeneic hematopoietic stem cell transplantation at Department of Hematology, Drum Tower Hospital affiliated to Nanjing University Medical College from May 2002 to September 2007 were selected. ~ 60 years old. Seven of the 14 patients were fully matched for human leukocyte antigen matching, and seven of the recipients were HLA-haploidentical. Eleven patients with hematopoietic stem cell transplantation who were matched with ABO blood type in the same period were included as controls. The recipient signed a transplant consent form prior to receiving allogeneic hematopoietic stem cell transplantation. The donor agreed to provide bone marrow for transplantation for siblings, siblings, sons and mothers. The experiment was approved by the hospital ethics committee. Methods: ① Pretreatment: Human Leukocyte Antigen Totally matched group take the main plan of Malilan and cyclophosphamide. Human leukocyte antigen haplotype haplogroup Beijing People’s Hospital using the GIAC program. ② hematopoietic stem cell infusion: sediment donor bone marrow, take the upper nucleated cells lost to the recipient. MAIN OUTCOME MEASURES: To observe the side effects, complications and hematopoietic reconstitution of ABO-incompatible allogeneic hematopoietic stem cell transplantation. Results: Only one case of simple erythrocyte aplasia in 14 patients with ABO incompatibility did not enter the result analysis. ① Reconstitution of hematopoietic function: Compared with the control group, hemoglobin recovery time was significantly delayed in ABO incompatible group (t = 2.352, P <0.05). There was no significant difference in the recovery of neutrophil and platelet between the same ABO blood group and ABO blood group Significance (P> 0.05). ABO incompatible human leukocyte antigen haploidentical hemopoietic stem cell hemoglobin recovery and blood conversion time later than the full match, but the difference was not significant (P> 0.05). ② complications: 14 cases of ABO incompatible blood transfusion in patients with no hemolytic reaction after transfusion, did not have delayed hemolysis after transplantation. Conclusion: ABO blood group does not affect the effect of hematopoietic stem cell transplantation, and more secure.