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目的总结162例异基因造血干细胞移植(allo-HSCT)[包括:同胞allo-HSCT125例,非血缘关系allo-HSCT30例和非清髓异基因外周血造血干细胞移植(allo-PBSCT)7例]治疗恶性血液病疗效和生存状况。方法慢性粒细胞白血病(CML)患者62例,急性髓系白血病(AML)患者58例,急性淋巴细胞白血病(ALL)患者28例,骨髓增生异常综合征(MDS)6例,多发性骨髓瘤(MM)3例,非霍奇金淋巴瘤(NHL)3例,慢性粒单细胞性白血病(CMML)1例,霍奇金淋巴瘤(HD)1例。经预处理,进行人类白细胞抗原(HLA)相合的同胞异基因骨髓移植(allo-BMT)27例,allo-PBSCT98例和非血缘关系allo-BMT4例,非血缘关系allo-PBSCT26例,HLA相合的同胞非清髓allo-PBSCT7例。非血缘关系allo-HSCT患者采用长程加强的移植物抗宿主病(GVHD)的预防方案(将环孢菌素A提前至预处理开始时使用,同时加用霉酚酸酯)。结果移植后中位随访38(2～259)个月。allo-HSCT患者长期DFS为54.9%(89/162),CML至今DFS为61.3%(38/62),AML至今DFS为56.9%(33/58),ALL至今DFS为39.3%(11/28),MDS至今DFS为83.3%(5/6),3例NHL存活1例,1例CMML存活,3例MM均死亡,霍奇金淋巴瘤(HD)1例死亡。移植后100d内移植相关死亡率(TRM)19.8%(32/162),死亡原因分别为急性GVHD、播散性感染、复发和植入失败;移植后100d至2年内TRM为24.7%(40/162),死亡原因分别为慢性GVHD、CMV感染和疾病复发,1例于移植后1413d死亡,其余移植超过2年均存活,死亡原因是慢性GVHD合并感染,最长生存已11年。结论allo-HSCT可使相当部分白血病患者获得长期无病存活,治疗MDS效果良好,治疗MM效果很差。该组患者移植后100d内死亡原因主要是急性GVHD;移植后100d至2年内死亡的主要原因是慢性GVHD和CMV感染、疾病复发;故除正确处理移植相关并发症、减少移植手术期死亡之外,还应加强患者移植后的医学监护和康复指导,进一步提高移植成功率。
Objective To summarize the clinical data of 162 allogeneic hematopoietic stem cell transplantation (allo-HSCT) [including: 125 cases of sibling allo-HSCT, 30 cases of non-blood relationship allo-HSCT and 7 cases of non-myeloablative allogeneic peripheral blood hematopoietic stem cell transplantation Hematologic malignancies and survival status. Methods Sixty-two patients with chronic myeloid leukemia (CML), 58 with acute myeloid leukemia (AML), 28 with acute lymphoblastic leukemia (ALL), 6 with myelodysplastic syndrome (MDS), 6 with multiple myeloma 3 cases of MM, 3 cases of non-Hodgkin’s lymphoma (NHL), 1 case of chronic myelomonocytic leukemia (CMML) and 1 case of Hodgkin lymphoma (HD). 27 cases of allogeneic bone marrow transplantation (allo-BMT), 98 cases of allo-PBSCT, 4 cases of non-blood relationship allo-BMT, 26 cases of non-blood relationship allo-PBSCT, HLA-matched Fellow non-myeloablative allo-PBSCT 7 cases. Non-blood-related allo-HSCT patients were treated with a long-term prophylaxis of graft versus host disease (GVHD) (cyclosporine A was advanced prior to the start of pretreatment and mycophenolate was added). Results The median follow-up was 38 (2 ~ 259) months after transplantation. The long-term DFS was 54.9% (89/162) in allo-HSCT patients, the DFS was 61.3% (38/62) in CML patients, the DFS was 56.9% (33/58) in AML patients and 39.3% (11/28) , DFS was 83.3% (5/6) in MDS so far, 1 patient survived in 3 patients with NHL, 1 patient died in CMML, 3 patients died in MM, and 1 patient died in Hodgkin lymphoma. Transplantation-related mortality (TRM) was 19.8% (32/162) within 100 days after transplantation. The causes of death were acute GVHD, disseminated infection, and recurrence and implantation failure respectively. TRM was 100% to 2 years after transplantation in 24.7% 162). The causes of death were chronic GVHD, CMV infection and disease recurrence respectively. One patient died after 1413 days of transplantation and the rest survived for more than 2 years. The cause of death was chronic GVHD infection with the longest life span of 11 years. Conclusion Allo-HSCT can make a considerable number of leukemia patients get long-term disease-free survival, treatment of MDS with good results, the treatment of MM is poor. This group of patients died within 100d after transplantation is the main cause of acute GVHD; 100d to 2 years after transplantation, the main cause of death is chronic GVHD and CMV infection, the disease recurrence; Therefore, in addition to the correct handling of transplant-related complications and reduce graft-related deaths , But also to strengthen medical care and rehabilitation guidance after transplantation, to further improve the success rate of transplantation.