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目的评价造血干细胞移植(HSCT)治疗血液病和实体瘤的临床疗效及并发症。方法回顾性分析61例行HSCT的患者,其中19例为自体造血干细胞移植(auto-HSCT),37例为异基因造血干细胞移植(allo-HSCT),5例非血缘脐血移植(UCBT)。结果除2例成人UCBT病例外,59例均获造血重建。在auto-HSCT、allo-HSCT(不包括UCBT病例)和UCBT后中性粒细胞绝对计数(ANC)≥0.5×109/L和血小板≥20×109/L所需的时间3组分别为(11.7±3.8)d和(12.7±5.4)d、(12.5±2.6)d和(13.8±4.3)d、(14.2±3.5)d和(30.4±10.5)d。auto-HSCT与allo-HSCT比较造血重建时间差异无显著性意义(P>0.05),但与UCBT组相比差异有极显著性意义(P<0.01)。allo-HSCT组急性移植物抗宿主病(aGVHD)发生率为24.3%,慢性移植物抗宿主病(cGVHD)发生率为35.1%,UCBT组未发生GVHD。auto-HSCT组、allo-HSCT组和UCBT组总生存率(OS),无病生存率(DFS)和累积复发率的Kaplan-Meier曲线无显著差异。auto-HSCT组中移植后免疫治疗组和非免疫治疗组的DFS及累积复发率的Kaplan-Meier曲线有显著差异。结论auto-HSCT与allo-HSCT的3年OS、DFS和复发率相当。auto-HSCT后的免疫治疗能有效降低复发率。非清髓造血干细胞移植(NST)对于有脏器功能受损或年龄大的患者是安全有效的,术后嵌合体的监测指导免疫抑制剂的调节和供者淋巴细胞输注(DLI)能有效预防复发。
Objective To evaluate the clinical efficacy and complications of hematopoietic stem cell transplantation (HSCT) in the treatment of hematological and solid tumors. Methods A total of 61 HSCT patients were retrospectively analyzed. Among them, 19 were auto-HSCT, 37 were allo-HSCT, and 5 were non-cord blood transplantation (UCBT). Results In addition to 2 cases of adult UCBT cases, 59 cases were reconstructed. The time required for neutrophil absolute count (ANC) ≥0.5 × 109 / L and platelet≥20 × 109 / L after auto-HSCT, allo-HSCT (excluding UCBT cases) and UCBT was (11.7 ± 3.8 d and 12.7 ± 5.4 d, 12.5 ± 2.6 d and 13.8 ± 4.3 d, 14.2 ± 3.5 d and 30.4 ± 10.5 d respectively. There was no significant difference between auto-HSCT and allo-HSCT in hematopoietic reconstructive time (P> 0.05), but there was significant difference between auto-HSCT and allo-HSCT (P <0.01). The incidence of acute graft-versus-host disease (aGVHD) was 24.3% in allo-HSCT group, 35.1% in chronic graft-versus-host disease (CGVHD), and no GVHD in UCBT group. The Kaplan-Meier curves of auto-HSCT group, allo-HSCT group and UCBT group showed no significant differences in OS, disease-free survival (DFS) and cumulative recurrence rate. The Kaplan-Meier curves of DFS and cumulative recurrence rate in auto-HSCT group after immunotherapy and non-immunotherapy group were significantly different. Conclusion The 3-year OS, DFS and relapse rate of auto-HSCT and allo-HSCT are similar. Immunotherapy after auto-HSCT can effectively reduce the recurrence rate. Non-myeloablative hematopoietic stem cell transplantation (NST) is safe and effective for patients with impaired organ function or in older age. The monitoring of postoperative chimerism guides the modulation of immunosuppressive agents and donor lymphocyte infusion (DLI) Prevent recurrence