Chen Feng, Wu De-Pei, Sun Ai-Ning, Ma Xiao, Tang Xiao-Wen, Qiu Hui-Ying, Miao Miao, Fu Zheng-Zheng, Jin Zheng-Ming, Wang Ying, Wu Xiao-Jin, Chen Su-Ning, He Guang-Sheng, Wang Xiu-Li, Xue Sheng-Li, Zhao Ye, Chang Wei-Rong
Department of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou 215006, China.
Zhonghua Xue Ye Xue Za Zhi. 2008 Feb;29(2):83-6.
To compare the clinical outcomes between unrelated donor hematopoietic stem cell transplantation (URD-HSCT) and HLA-haploidentical (Hi)-HSCT.
Twenty-five patients with hematologic malignancies received URD-HSCT and thirty patients received Hi-HSCT. The conditioning regimen consisted of modified BUCY or modified total body irradiation (TBI) plus CY. Acute graft-versus-host disease (aGVHD) prophylaxis consisted of cyclosporin ( CsA), short-term methotrexate (MTX), mycophenolate mofetil (MMF), or the combination of CsA, MTX and MMF plus antithymocyte globulin (ATG) or antilymphocyte globulin (ALG), or the combination of CsA, MTX, MMF, ATG/ ALG and CD25 monoclonal antibody.
All patients in the URD-HSCT group and 29 patients in the Hi-HSCT group were engrafted successfully. The median follow-up duration was 7 (2 -59) months for URD-HSCT group and 7.3 (1 - 35) months for Hi-HSCT group. The 3-year probabilities of disease-free survival (DFS) for URD-HSCT and Hi-HSCT group were (54.1 +/- 11.9)% and (43.1 +/- 9.1)%, respectively (P =0.13). Grade III - IV aGVHD occurred in 10 patients in URD-HSCT group and 11 in Hi-HSCT group (the cumulative incidence 40.0% vs 37.9%, P > 0.05), respectively. Ten patients (40.0%) died of transplantation-related mortality (TRM) in URD-HSCT group and 17 (56.7%) in Hi-HSCT group (P >0. 5). Two patients relapsed in each group (the rate of relapse 8.0% vs 6.0%, P >0.05). The primary causes of death included severe aGVHD with infection,severe pulmonary infection and relapse.
Both URD-HSCT and Hi-HSCT are effective and curable treatment for refractory or high-risk hematologic malignancies. The optimal donor should be chose individually. The severe aGVHD and consequent infection are still the main cause of TRM.
比较非亲缘供者造血干细胞移植（URD-HSCT）与HLA单倍型相合（Hi）-HSCT的临床疗效。
25例血液系统恶性肿瘤患者接受URD-HSCT，30例患者接受Hi-HSCT。预处理方案包括改良BUCY或改良全身照射（TBI）加环磷酰胺（CY）。急性移植物抗宿主病（aGVHD）预防方案包括环孢素（CsA）、短期甲氨蝶呤（MTX）、霉酚酸酯（MMF），或CsA、MTX和MMF联合抗胸腺细胞球蛋白（ATG）或抗淋巴细胞球蛋白（ALG），或CsA、MTX、MMF、ATG/ALG和CD25单克隆抗体联合使用。
URD-HSCT组所有患者及Hi-HSCT组29例患者均成功植入。URD-HSCT组中位随访时间为7（2-59）个月，Hi-HSCT组为7.3（1-35）个月。URD-HSCT组和Hi-HSCT组3年无病生存率（DFS）分别为（54.1±11.9）%和（43.1±9.1）%（P=0.13）。URD-HSCT组10例患者发生Ⅲ-Ⅳ度aGVHD，Hi-HSCT组11例（累积发生率40.0%对37.9%，P>0.05）。URD-HSCT组10例患者（40.0%）死于移植相关死亡率（TRM），Hi-HSCT组17例（56.7%）（P>0.5）。两组各有2例患者复发（复发率8.0%对6.0%，P>0.05）。死亡的主要原因包括严重aGVHD合并感染、严重肺部感染和复发。
URD-HSCT和Hi-HSCT都是治疗难治性或高危血液系统恶性肿瘤的有效且可治愈的方法。应个体化选择最佳供者。严重aGVHD及随之而来的感染仍是TRM的主要原因。
