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目的评价无关供体外周血干细胞和骨髓移植的造血重建、T细胞重建、感染、GVHD及疗效的差异。方法46例患者接受无关供体造血干细胞移植(URD-HSCT),其中16例患者接受无关供者外周血干细胞移植(外周血组),30例患者接受无关供者骨髓移植(骨髓组)。流式细胞仪测定移植后1年内不同时间点患者的T细胞免疫重建。统计分析两组患者移植后白细胞(WBC)和血小板(BPC)重建时间,T细胞重建,感染发生率,移植物抗宿主病(GVHD)、白血病复发、无病生存(DFS)情况。结果除1例骨髓干细胞移植患者未造血重建外,其余45例均获得造血重建。外周血组和骨髓组WBC重建时间分别为+(12.81±4.15)和+(16.21±3.09)d(P=0.003);白细胞重建时间分别为+(15.50±6.91)和+(20.31±7.19)d(P=0.035),外周血组白细胞和血小板重建时间均快于骨髓组。外周血组和骨髓组患者移植后1、3、6、9、12月的T细胞重建无显著性差异。外周血组和骨髓组的移植后早期感染发生率分别为37.50%和50.00%,二者无显著性差异(P=0.644)。外周血组与骨髓组急性GVHD(aGVHD)的发生率分别为56.25%和70.00%,其中Ⅲ-Ⅳ°aGVHD的发生率在二组分别为18.75%和13.79%;在可统计的患者中,慢性GVHD(cGVHD)的发生率外周血组为30.77%(4/13),骨髓组为36.36%(8/22),aGVHD和cGVHD发生率二组比较均无差异(P值分别为0.456和0.413)。非白血病复发移植相关死亡率外周血组和骨髓组分别为18.75%和33.33%,二者无显著性差异(P=0.295)。外周血组与骨髓组移植后分别有3例和2例复发,二者的复发率无显著性差异(P=0.226);移植后2年DFS在外周血组与骨髓组分别为62.19%和56.23%,二者无显著性差异(P=0.615)。结论无关供体外周血干细胞移植后的造血重建比骨髓移植迅速,但两者间移植后T细胞重建、感染发生率、GVHD及DFS并无显著性差异。
Objective To evaluate the differences of hematopoietic reconstitution, T cell reconstruction, infection, GVHD and curative effect between unrelated donor peripheral blood stem cells and bone marrow transplantation. Methods Sixty-six patients underwent unrelated donor stem cell transplantation (URD-HSCT). Sixteen patients underwent donor-free peripheral blood stem cell transplantation (peripheral blood group), and 30 patients underwent donor-free bone marrow transplantation. Flow cytometry was used to measure T cell immune reconstitution in patients at different time points after transplantation. The time of reconstruction of WBC and BPC, the reconstruction of T cells, the incidence of infection, GVHD, relapse of leukemia and disease-free survival (DFS) were analyzed statistically in the two groups. Results All the other 45 cases were given hematopoietic reconstitution except one case of bone marrow stem cell transplantation without hematopoietic reconstitution. The WBC reconstruction time was (12.81 ± 4.15) and (16.21 ± 3.09) d in the peripheral blood group and the bone marrow group respectively (P = 0.003). The leukocyte reconstruction time was + (15.50 ± 6.91) and + (20.31 ± 7.19) d (P = 0.035). The time of leukocyte and platelet reconstruction in peripheral blood was faster than that in bone marrow. There were no significant differences in T cell remodeling at 1, 3, 6, 9, and 12 months after transplantation in the peripheral blood group and the bone marrow group. The incidence of early posttransplant infection in peripheral blood and bone marrow groups were 37.50% and 50.00%, respectively, with no significant difference (P = 0.644). The incidences of acute GVHD (aGVHD) in peripheral blood and bone marrow group were 56.25% and 70.00%, respectively. The incidence of aGVHD of Ⅲ-Ⅳ ° in the two groups was 18.75% and 13.79% respectively. Among the statistically significant patients, chronic The incidence of GVHD (cGVHD) was 30.77% (4/13) in peripheral blood and 36.36% (8/22) in bone marrow, and the incidence of aGVHD and cGVHD was no significant difference between the two groups (P = 0.456 and 0.413, respectively) . Non-leukemia relapse-related mortality mortality rate of peripheral blood and bone marrow were 18.75% and 33.33%, no significant difference between the two (P = 0.295). Peripheral blood and bone marrow transplantation group, there were 3 cases and 2 cases of recurrence, the recurrence rate was no significant difference (P = 0.226); 2 DFS in peripheral blood and bone marrow group were 62.19% and 56.23 %, No significant difference between the two (P = 0.615). Conclusions Independent donor HSCs have a faster hematopoietic reconstitution than bone marrow transplantation, but there is no significant difference in T cell reconstitution, incidence of infection, GVHD and DFS after transplantation.