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目的对比非血缘相合及血缘单倍体相合供者来源异基因造血干细胞移植(allo-HSCT)的疗效及安全性。方法分析2009年12月至2013年8月期间在解放军第三〇九医院接受非血缘相合供者来源造血干细胞移植(UD-HSCT)31例与血缘单倍体相合供者来源造血干细胞移植(Hi-HSCT)28例高危或难治性急性白血病患者临床资料。移植预处理方案采用改良白舒非加环磷酰胺(BUCY)或环磷酰胺/全身放疗(CY/TBI);移植物抗宿主病(GVHD)预防采用抗胸腺细胞球蛋白(ATG)、环孢菌素、甲氨蝶呤及霉酚酸酯联合方案;肝静脉闭塞病(VOD)采用前列腺素E联合低分子肝素、复方甘草酸苷预防。两组患者GVHD发生率比较用c2检验,造血恢复时间比较用t检验,两组患者生存及移植相关死亡采用Kaplan-Meier生存曲线分析,Log-rank检验进行组间生存比较。结果所有患者均获造血重建,UD-HSCT与Hi-HSCT两组中性粒细胞中位重建时间分别为10.8(9~18)d及10.6(9~16)d(P>0.05),3年无病生存率(DFS)分别为48.3﹪及50.5﹪(P>0.05),两组总生存率(OS)分别为54.8﹪和57.1﹪(P>0.05)。UD-HSCT与Hi-HSCTⅢ~Ⅳ度GVHD发生率分别为(7例)22.5﹪和(5例)17.8﹪(P>0.05),UD-HSCT组1例发生重度VOD死亡;两组移植相关死亡(TRM)分别为14例(45﹪)与12例(43﹪)(P>0.05),因复发死亡病例分别为8例(57.1﹪)与6例(50﹪)(P>0.05)。结论 UD-HSCT与Hi-HSCT治疗高危或难治急性白血病患者可取得相似的疗效,两者均可作为无同胞相合供者高危难治白血病的有效选择方案。
Objective To compare the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with non-blood matched and hemophilic haploidentical donor. Methods Thirty-one cases of hematopoietic stem cell transplantation (UD-HSCT) from non-hemophagocytic donors in the 309th Hospital of People’s Liberation Army between December 2009 and August 2013 were analyzed retrospectively. Hematopoietic stem cell transplantation -HSCT) 28 cases of high-risk or refractory acute leukemia in patients with clinical data. The transplantation pretreatment regimen was treated with either BUCY or CY / TBI. Graft versus host disease (GVHD) Mycophenolate, methotrexate and mycophenolate regimen; hepatic veno-occlusive disease (VOD) with prostaglandin E combined with low molecular weight heparin, compound glycyrrhizin prevention. The incidence of GVHD in both groups was compared by c2 test. The hematopoietic recovery time was compared by t test. The survival and transplant-related deaths of two groups were analyzed by Kaplan-Meier survival curve and Log-rank test. Results All patients underwent hematopoietic reconstitution. The median neutrophil reconstruction time was 10.8 (9-18) days and 10.6 (9-16 days) respectively in UD-HSCT and Hi-HSCT groups (P> 0.05) The disease-free survival rates (DFS) were 48.3% and 50.5%, respectively (P> 0.05). The overall survival rates were 54.8% and 57.1% in both groups (P> 0.05). The incidences of grade Ⅲ ~ Ⅳ GVHD in UD-HSCT and Hi-HSCT were 22.5% (7 cases) and 17.8% (5 cases) respectively in UD-HSCT group, and 1 case had severe VOD death in UD-HSCT group. (TRM) were 14 (45%) and 12 (43%) respectively. There were 8 death cases (57.1%) and 6 (50%) died of recurrence (P> 0.05). Conclusion Both UD-HSCT and Hi-HSCT can achieve similar curative effect in patients with high-risk or refractory acute leukemia, both of which can be used as an effective choice for high-risk refractory leukemia without sibling donor.