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背景:对于无HLA全相合同胞供者的患者,采用单倍体相合造血干细胞移植面临移植物抗宿主病重、移植相关死亡率高的风险,但通过不同的移植模式,将有可能获取相近的疗效。目的:观察亲缘HLA单倍体相合异基因造血干细胞移植治疗白血病的疗效,并与亲缘HLA全相合异基因造血干细胞移植相比较。方法:45例白血病患者分为2组。单倍体组移植方式为外周血或联合骨髓干细胞移植,预处理方案为改良白消安与环磷酰胺或加抗胸腺细胞球蛋白,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤+霉酚酸脂;全相合组移植方式为外周血干细胞移植,预处理方案为BuCY,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤。结果与结论:两组均获得造血重建时间差异无显著性意义。单倍体及全相合组急性移植物抗宿主病的累积发病率分别为73%对52%(P>0.05);慢性移植物抗宿主病的累积发病率分别为56%对45%(P>0.05);移植相关死亡率分别为36%对17%(P>0.05);单倍体组无复发,全相合组复发2例;两组的预计3年累积无病生存率分别为61%对60%(P>0.05)。结果提示,亲缘单倍体异基因造血干细胞移植的总体疗效与亲缘全相合异基因造血干细胞移植相似,但中重度急性移植物抗宿主病的发生率较后者为高。
Background: Haploid haploidentical hematopoietic stem cell transplantation faces a high risk of graft-versus-host disease and transplant-related mortality in patients without any HLA-identical sibling donor but with different transplantation patterns it is possible to obtain similar Efficacy. Objective: To observe the efficacy of HLA haploidentical allogeneic hematopoietic stem cell transplantation in the treatment of leukemia, and to compare with HLA-identical allogeneic hematopoietic stem cell transplantation. Methods: 45 leukemia patients were divided into two groups. Haploidentical transplantation for peripheral blood or bone marrow stem cell transplantation, preconditioning programs for the improvement of busulfan and cyclophosphamide or anti-thymocyte globulin, graft versus host disease prevention using cyclosporine A + methotrexate Neomycin + mycophenolate mofetil. Allograft transplantation was peripheral blood stem cell transplantation. The pretreatment protocol was BuCY. Cyclosporine A + methotrexate was used in the prevention of graft-versus-host disease. RESULTS AND CONCLUSION: There was no significant difference between the two groups in the time of hematopoietic reconstitution. The cumulative incidence of acute graft versus host disease in haploids and allzymes was 73% versus 52%, respectively (P> 0.05). The cumulative incidence of chronic graft versus host disease was 56% versus 45%, respectively (P> 0.05). The mortality rates of transplantation were 36% vs 17% (P> 0.05) respectively. There was no recurrence in haploid group and 2 cases in all-matched group. The expected cumulative 3-year disease-free survival rates of the two groups were 61% 60% (P> 0.05). The results suggest that the overall efficacy of haploid allogeneic hematopoietic stem cell transplantation is similar to that of allogeneic allogeneic hematopoietic stem cell transplantation, but the incidence of moderate-severe acute graft-versus-host disease is higher than that of the latter.