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本研究探讨(G-CSF)动员骨髓加外周血联合进行单倍体相合造血干细胞移植(hiBM+PBSCT)治疗白血病的可行性及疗效。125例白血病患者接受了单倍体相合未去T细胞的造血干细胞移植。所有供者应用G-CSF5μg/(kg.d),皮下注射,连用7天。实验组(A组)29例患者在供者动员的第7、8天分别接受1次hiBMT+PBSCT移植;对照组(B组)96例仅接受1次单倍体相合骨髓造血干细胞移植(hiBMT)。对两组患者应用相同的免疫抑制剂预防急性GVHD,观察临床的移植效果。结果表明:除hiBMT组有1例慢性髓系白血病合并骨髓纤维化患者移植失败外,其余全部患者移植后经检测证实为完全供者造血,hiBM+PBSCT组和hiBMT组中性粒细胞数>0.5×109/L的中位时间分别为15(10-23)天和19(11-26)天;血小板数>20×109/L时间分别为18(9-33)天和23(13-35)天。hiBM+PBSCT组和hiBMT组急性Ⅱ-Ⅳ度aGVHD的累计发生率分别是31.03%和12.5%,二者差异有显著性意义(p<0.05),但急性Ⅲ-Ⅳ度aGVHD的发生率分别是13.79%和10.41%(p>0.05)、aGVHD相关死亡率分别为3.45%和5.21%(p>0.05),差异均无显著性意义。骨髓联合外周血移植组和单纯骨髓移植组慢性GVHD的累计发生率分别是48.2%和35.4%(p>0.05),二者差异无显著性意义。广泛型慢性GVHD发生率两组分别为23.3%和15.6%(p>0.05),差异无显著性意义。骨髓联合外周血移植组和单纯骨髓移植组疾病复发率分别是6.8%(2/29)和18.7%(18/96)(p<0.05),二者差异有显著性意义。结论:G-CSF动员骨髓联合外周血单倍体相合造血干细胞移植后造血重建更快,急性Ⅲ-Ⅳ度GVHD发生率和死亡率无明显增加,高危白血病的复发率下降,可以有效安全应用于临床。
This study was to investigate the feasibility and efficacy of G-CSF mobilization of bone marrow plus peripheral blood combined with haploidentical hematopoietic stem cell transplantation (hiBM + PBSCT) in the treatment of leukemia. 125 leukemia patients underwent haploidentical hematopoietic stem cell transplantation without T cells. All donors used G-CSF5μg / (kg.d), subcutaneous injection, once every 7 days. Twenty-nine patients in the experimental group (group A) received one hiBMT + PBSCT on the 7th and 8th day after the donor mobilization, while 96 patients in the control group (B) received only one haploidentical bone marrow hematopoietic stem cell transplantation (hiBMT ). The same immunosuppressive agents were used to prevent acute GVHD in both groups and the effect of clinical transplantation was observed. The results showed that except for one case of chronic myeloid leukemia with myelofibrosis in hiBMT group, all the patients were proved to be complete donor hematopoiesis after transplantation. The number of neutrophils in hiBM + PBSCT group and hiBMT group was> 0.5 The median time to x 109 / L was 15 (10-23) days and 19 (11-26) days respectively; the platelet counts> 20 x 109 / L were 18 (9-33) days and 23 )day. The cumulative incidence of acute grade Ⅱ-Ⅳ aGVHD in hiBM + PBSCT group and hiBMT group was 31.03% and 12.5%, respectively, with significant difference (p <0.05), but the incidence of acute grade Ⅲ-Ⅳ aGVHD was 13.79% and 10.41%, respectively (p> 0.05). The aGVHD related mortality rates were 3.45% and 5.21% respectively (p> 0.05), with no significant difference. The cumulative incidence of chronic GVHD in bone marrow combined with peripheral blood transplantation group and simple bone marrow transplantation group was 48.2% and 35.4% respectively (p> 0.05), but the difference was insignificant. The incidence of extensive chronic GVHD was 23.3% and 15.6% in both groups (p> 0.05), with no significant difference between the two groups. The recurrence rates of bone marrow combined with peripheral blood transplantation group and simple bone marrow transplantation group were 6.8% (2/29) and 18.7% (18/96) respectively (p <0.05), and the difference was significant. Conclusion: The hematopoietic reconstitution after G-CSF mobilization combined with haploidentical hematopoietic stem cell transplantation in peripheral blood is faster, the incidence and mortality of acute GVHD Ⅲ-Ⅳ are not significantly increased, and the relapse rate of high-risk leukemia is decreased, which can be safely and safely applied to clinical.