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通过比较异基因外周血造血干细胞移植(PBSCT)与其联合骨髓移植(BMT)治疗白血病过程中造血重建时间、移植物抗宿主病(GVHD)发生率及生存率,探讨二者联合移植对白血病治疗的影响。回顾性分析2003年1月至2009年1月在郑州大学第一附属医院接受全相合异基因造血干细胞移植的152例患者,其中78例单纯接受外周血造血干细胞移植,74例接受外周血造血干细胞移植联合骨髓移植。预处理方案:152例患者均应用改良Bu/CY方案预处理,环孢素A(CsA)联合甲氨蝶呤(MTX)、吗替麦考酚酯(MMF)预防GVHD,流式细胞仪测定外周及骨髓造血干细胞计数。SPSS17.0统计分析两组患者移植后造血重建时间、GVHD的发生率及2年生存率。结果:1、移植后造血重建:接受外周血造血干细胞移植与联合骨髓移植患者的白细胞及血小板重建时间无显著性差异(血小板>20×109/L时间分别为(14.18±4.713)d和(12.55±6.552)d(P>0.05),中性粒细胞>0.5×109/L的时间分别为(12.08±3.586)d和(11.64±5.540)d(P>0.05);2、GVHD:接受PBSCT及联合BMT患者Ⅲ度到Ⅳ度急性GVHD(aGVHD)发生率比较有显著性差异(P=0.05)。两者慢性GVHD(cGVHD)发病率有显著性差异(P=0.01);3、2年生存率:接受外周血干细胞移植及其联合骨髓移植患者2年无病生存率和总生存率无显著性差异(P>0.05)。提示,异基因造血干细胞移植与其联合骨髓移植比较造血重建时间及2年生存率无明显差异,但前者GVHD发生率较高,因此外周血造血干细胞移植联合骨髓移植可能减少急性及慢性GVHD的发生。
To compare the incidence of hematopoietic reconstitution, graft-versus-host disease (GVHD) and survival rate in patients with leukemia treated by allogeneic peripheral blood hematopoietic stem cell transplantation (PBSCT) combined with bone marrow transplantation (BMT) influences. A total of 152 patients undergoing total phase allogeneic hematopoietic stem cell transplantation at the First Affiliated Hospital of Zhengzhou University from January 2003 to January 2009 were retrospectively analyzed. Among them, 78 received simple peripheral blood stem cell transplantation and 74 received hematopoietic stem cell Transplantation combined with bone marrow transplantation. Pretreatment: 152 patients were treated with modified Bu / CY regimen, cyclosporine A (CsA) combined with methotrexate (MTX), mycophenolate mofetil (MMF) to prevent GVHD, flow cytometry Peripheral and bone marrow hematopoietic stem cell counts. SPSS17.0 statistical analysis of two groups of patients after transplantation hematopoietic reconstruction time, the incidence of GVHD and 2-year survival rate. The hematopoietic reconstitution after transplantation: there was no significant difference in the time of leukocyte and platelet reconstruction between the patients receiving hematopoietic stem cell transplantation and bone marrow transplantation (platelet> 20 × 109 / L for (14.18 ± 4.713) d and (12.55 ± 6.552) d (P> 0.05), neutrophils> 0.5 × 109 / L for 12.08 ± 3.586 days and 11.64 ± 5.540 days respectively (P> 0.05) The incidence of acute GVHD (Ⅲ-Ⅳ) acute GVHD (aGVHD) in patients with combined BMT was significantly different (P = 0.05) .The incidence of chronic GVHD (cGVHD) was significantly different between the two groups (P = 0.01) Rate: There was no significant difference in 2-year disease-free survival rate and overall survival between patients receiving PBSC and BMT (P> 0.05), suggesting that allogeneic hematopoietic stem cell transplantation combined with BMT compared hematopoietic reconstitution time and 2 The annual survival rate was no significant difference, but the former a high incidence of GVHD, so peripheral blood hematopoietic stem cell transplantation combined with bone marrow transplantation may reduce the incidence of acute and chronic GVHD.