外周血造血干细胞移植治疗重型再生障碍性贫血23例分析

洪嘉欣; 刘小云; 张然; 游泳; 仲照东; 夏凌辉

外周血造血干细胞移植治疗重型再生障碍性贫血23例分析

- 1. 华中科技大学第一临床学院(武汉, 430022);
- 2. 华中科技大学同济医学院附属协和医院血液科

详细信息

通讯作者: 夏凌辉,E-mail:xlh64@medmail.com.cn

中图分类号: R556.5

收稿日期: 2013-04-22

Hematopoietic stem cell transplantation for 23 patients with severe aplastic anemia

- 1. the First Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China;
- 2. Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

More Information

Corresponding author: XIA Linghui, E-mail: xlh64@medmail.com.cn

Received Date: 22 April 2013

摘要

摘要: 目的：探讨外周血造血干细胞移植（HSCT）治疗重型再生障碍性贫血（SAA）的疗效。方法：回顾性分析23例接受外周血HSCT治疗的SAA患者的植活情况、移植物抗宿主病（GVHD）和移植相关并发症发生情况及影响预后的因素等。结果：23例患者中，22例造血重建，白细胞和血小板中位植活时间分别为移植后15（7~21） d、19（7~32） d，其中4例患者出现急性GVHD，发生率为18.2%（4/22），3例出现慢性GVHD，发生率为13.6%（3/22）；1例未植活死亡，总体生存率为95.7%（22/23）。22例造血重建患者中，移植后发生巨细胞病毒感染4例，有出血表现8例，出血性膀胱炎1例，肺部感染7例，口角疱疹1例，化脓性扁桃体炎1例。另外，移植前有无感染及诊断到移植的间隔时间是影响患者预后的危险因素。结论：HSCT是治疗SAA的有效方法，加强移植前后的免疫抑制剂治疗，预防和控制感染，能有效地减少GVHD的发生，改善预后。
- 造血干细胞移植 /
- 重型再生障碍性贫血
Abstract: Objective: To explore the efficacy of hematopoietic stem cell transplantation (HSCT) in treating severe aplastic anemia (SAA).Method: We retrospectively analyzed the effectiveness,graft-versus-host diseases (GVHD),transplant-related complications and factors affecting the prognosis of 23 patients with SAA who received HSCT.Result: Twenty-two patients achieved hematopoiesis reconstitution.The median graft survival time of white blood cells and platelets were 15(7-21) days and 19(7-32) days,respectively.Four patients (18.2%) developed acute GVHD and 3 cases (13.6%) developed chronic GVHD.One patient died of un-engraftment,and the overall survival rate was 95.7%.As for the complications,CMV infection was found in 4 patients after HSCT,bleeding manifestations was in 8 cases,hemorrhagic cystitis was in 1 case,pulmonary infection was in 7 cases,mouth herpes in 1 case and suppurative tonsillitis was in 1 case.Moreover,infections before HSCT and the time interval from diagnosis to transplantation were risk factors influencing the prognosis.Conclusion: HSCT is an effective approach for patients with SAA.Enhancing immunosuppressive therapy before and after HSCT,and prevention and control of the infection can effectively reduce the incidence of GVHD and improve the prognosis.
- hematopoietic stem cell transplantation /
- severe aplastic anemia

HTML全文

参考文献(10)

[1]	刘苹,朱传江.再生障碍性贫血的研究进展[J].临床和实验医学杂志,2009,8(2):137-140.
[2]	INAMOTO Y,SUZUKI R,KUWATSUKA Y,et al.Long-term outcome after bone marrow transplantation for aplastic anemia using cyclophosphamide and total lymphoid irradiation as conditioning regimen[J].Biol Blood Marrow Transplant,2008,14:43-49.
[3]	中华医学会血液学分会红细胞疾病(贫血)学组.再生障碍性贫血诊断治疗专家共识[J].中华血液学杂志,2010,31(11):790-792.
[4]	美国西雅图Fred Hutchinson癌症研究中心医学联合体.造血干细胞移植标准实践手册[M].北京:人民卫生出版社,2007:238-241,301-303.
[5]	TICHELLI A,SCHREZENMEIER H,SOCIE G,et al.A randomized controlled study in patients with newly diagnosed severe aplastic anemia receiving antithymocyte globulin (ATG),cyclosporine,with or without G-CSF[J].Blood,2011,117:4434-4441.
[6]	ALJURF M,AL-ZAHRANI H,VAN LINT M T,et al.Standard treatment of acquired SAA in adult patients 18~40 years old with an HLA-identical sibling donor[J].Bone Marrow Transplant,2013,48:178-179.
[7]	翟卫华,王玫,周征,等.异基因造血干细胞移植治疗再生障碍性贫血16例临床观察[J].中华血液学杂志,2007,28(2):78-82.
[8]	ARMAND P,ANTIN J H.Allogeneic stem cell transplantation for aplastic anemia[J].Biol Blood Marrow Transplant,2007,13:505-516.
[9]	朱玲,薛梅,王志东,等.异基因造血干细胞移植治疗重型再生障碍性贫血的疗效研究[J].中国全科医学,2011,14(17):1925-1927.
[10]	范辉,靖彧,李红华,等.ABO血型不合异基因造血干细胞移植后并发纯红系再生障碍[J].中国实验血液学杂志,2008,16(2):364-367.