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目的观察异基因造血干细胞移植(allo-HSCT)后淋巴细胞增殖性疾病(PTLD)的临床特征、治疗及转归。方法 9例(4例急性淋巴细胞白血病,2例淋巴瘤,2例再生障碍性贫血和1例急性髓系白血病)患者行allo-HSCT。预处理方案包括:4例全身放疗(TBI)+环磷酰胺(CY)+依托泊苷(VP-16)、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+CY、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+VP-16、2例Flu+CY、1例TBI+CY。以环孢素A(CSA)、霉酚酸酯(MMF)、抗淋巴细胞球蛋白(ATG)加短程甲氨蝶呤(MTX)预防aGVHD。结果 9例患者发生PTLD的中位时间为移植后60(42-510)天,8例伴前驱EB病毒感染,4例出现PTLD中枢侵犯。经美罗华外周静脉注入及鞘内注射治疗,7例患者病情得以控制,2例死亡,治疗总有效率为77.7%。结论 PTLD是allo-HSCT后少见的最严重并发症之一,美罗华外周静脉注入及鞘内注射治疗PTLD合并中枢侵犯效果明显,为一线治疗方案。
Objective To observe the clinical characteristics, treatment and outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) after lymphoproliferative disorders (PTLD). Methods Allo-HSCT was performed in 9 patients (4 acute lymphoblastic leukemia, 2 lymphoma, 2 aplastic anemia and 1 acute myeloid leukemia). Pretreatment included 4 cases of TBI plus VP-16 and 1 case of Flu + Ara-c + TBI + CY, 1 Flu + Ara-c + TBI + VP-16, 2 Flu + CY and 1 TBI + CY. Cyclosporine A (CSA), mycophenolate mofetil (MMF), anti-lymphocyte globulin (ATG) plus short-range methotrexate (MTX) prevent aGVHD. Results The median time to PTLD occurred in 9 patients was 60 (42-510) days after transplantation, 8 with precursor EB virus infection, and 4 with PTLD central invasion. After rituximab injection and intrathecal injection, 7 patients were under control and 2 patients died. The total effective rate was 77.7%. Conclusions PTLD is one of the most serious complication after allo-HSCT. Rituximab injection and intrathecal injection have obvious effect of PTLD combined with central invasion, which is the first-line treatment.