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目的:观察减低剂量的兔抗人胸腺细胞免疫球蛋白(ATG)用于预防高危急性白血病HLA半相合造血干细胞移植后移植物抗宿主病(GVHD)的疗效及其对移植后造血植入、疾病复发及患者生存的影响。方法:2010-05-2013-12我院血液内科收治的4例高危急性白血病患者在HLA半相合外周血造血干细胞移植中,采用减低剂量的ATG(3例总剂量7.5 mg/kg,1例8.75 mg/kg)联合环孢素A、短程甲氨蝶呤及霉酚酸酯预防GVHD,观察移植后造血重建、GVHD、出血性膀胱炎及病毒感染的发生情况以及移植后复发和总生存情况。结果:4例患者均获得造血重建,移植后3~4周检测供受者嵌合率均为100%,1例出现急性GVHD,2例出现慢性GVHD,3例移植后出现巨细胞病毒血症,1例出现EB病毒血症,1例出现移植后淋巴增殖性疾病,3例分别于移植后6、10及12个月复发,1例复发后行DLI获得二次缓解。1年、3年总生存率分别为75%和25%。结论:HLA半相合造血干细胞移植治疗高危急性白血病时减低剂量ATG可能对造血植入无影响,GVHD发生率未见显著增加,能否降低复发率尚需进一步扩大病例数进行观察。
OBJECTIVE: To observe the therapeutic effect of reduced dose of anti-human thymocyte immunoglobulin (ATG) on patients with graft-versus-host disease (GVHD) after HLA haploidentical hematopoietic stem cell transplantation for high-risk acute leukemia and its effect on hematopoietic engraftment, Recurrence and the impact of patient survival. METHODS: Four patients with high-risk acute leukemia admitted to Department of Hematology, Huazhong University of Science and Technology were treated with ATG reduced dose (7.5 mg / kg in total and 8.75 in one) in HLA haploidentical peripheral blood stem cell transplantation mg / kg) combined cyclosporin A, short-course methotrexate and mycophenolate mofetil to prevent GVHD. The incidence of hematopoietic reconstitution, GVHD, hemorrhagic cystitis and viral infection after transplantation and recurrence and overall survival after transplantation were observed. Results: All the 4 patients received hematopoietic reconstitution. The donor chimerism rate was 100% at 3 to 4 weeks after transplantation. One case had acute GVHD, two cases had chronic GVHD and three cases had cytomegalovirus , One case of EB viremia, one case of post-transplant lymphoproliferative disease, three cases relapsed 6, 10 and 12 months after transplantation, and one case relapsed after second DLI. The 1-year, 3-year overall survival rates were 75% and 25%, respectively. Conclusion: It is suggested that the reduction of ATG dose may reduce the incidence of GVHD and reduce the recurrence rate.