Wu T, Lu D-P
Beijing Daopei Hospital, Beijing, China.
Bone Marrow Transplant. 2008 Aug;42 Suppl 1:S73-S75. doi: 10.1038/bmt.2008.123.
Syngeneic BMT was first performed successfully in China in 1964. In 1981, allogeneic BMT was applied in an acute leukemia patient with success. Since then, the number of BMTs has been increasing gradually, especially since the 1990s. More than 2000 stem cell transplants per year have been performed in recent years in more than 50 BMT units in mainland China. A survey of 16 BMT units from 1986 to 2005 indicates that the predominant types of transplantation performed are identical sibling (36%), related mismatched/haploidentical (11.2%), unrelated (7.5%) and autologous (44.5%) and that the distribution of disease entities and prevalent diseases being transplanted are AML (31%), ALL (16.1%), CML (19.1%) and lymphoid malignancy (22.2%). The number of transplants from unrelated donor or related mismatched/haploidentical donor has increased significantly in the past 5 years. BM and G-CSF-mobilized peripheral blood are used about equally often as a source of hematopoietic stem cells, or they are used in combination. Umbilical cord blood is used least often. Leukemias for allogeneic and lymphoid malignancies for autologous BMT continue to increase, but the increase in BMT for CML has been slow since 2004. By the end of 2007, HLA data were available on more than 700,000 individuals in the Chinese Marrow Donor Program, and 800 stem cell donations have been carried out from these. Related HLA-mismatched/haploidentical BMT has achieved comparable outcomes in terms of severe acute GVHD, chronic GVHD, relapse, treatment-related mortality, disease-free survival (DFS) and overall survival (OS) with HLA-identical sibling transplantation in the author's two BMT units. Cord blood co-infusion as the third-party cells could significantly reduce the incidence and severity of acute GVHD, steroid-refractory acute GVHD and extensive chronic GVHD without an increase in leukemia relapse and could improve DFS and OS.
同基因骨髓移植于1964年在中国首次成功实施。1981年，异基因骨髓移植应用于一名急性白血病患者并取得成功。从那时起，骨髓移植的数量逐渐增加，特别是自20世纪90年代以来。近年来，中国大陆50多个骨髓移植单位每年进行2000多例干细胞移植。一项对16个骨髓移植单位1986年至2005年情况的调查表明，进行的主要移植类型为同卵同胞（36%）、亲属配型不合/单倍体相合（11.2%）、非亲属（7.5%）和自体（44.5%），且移植的疾病实体分布及常见疾病为急性髓系白血病（31%）、急性淋巴细胞白血病（16.1%）、慢性髓系白血病（19.1%）和淋巴系统恶性肿瘤（22.2%）。在过去5年中，来自非亲属供者或亲属配型不合/单倍体相合供者的移植数量显著增加。骨髓和粒细胞集落刺激因子动员的外周血作为造血干细胞来源的使用频率大致相同，或者二者联合使用。脐带血使用频率最低。异基因移植治疗的白血病和自体骨髓移植治疗的淋巴系统恶性肿瘤持续增加，但自2004年以来慢性髓系白血病的骨髓移植增长缓慢。到2007年底，中华骨髓库中70多万人有人类白细胞抗原数据，已从中进行了800例干细胞捐献。在作者所在的两个骨髓移植单位，亲属人类白细胞抗原配型不合/单倍体相合骨髓移植在严重急性移植物抗宿主病、慢性移植物抗宿主病、复发、治疗相关死亡率、无病生存期（DFS）和总生存期（OS）方面与人类白细胞抗原相合的同胞移植取得了相当的结果。作为第三方细胞的脐带血共输注可显著降低急性移植物抗宿主病、激素难治性急性移植物抗宿主病和广泛性慢性移植物抗宿主病的发生率及严重程度，且不增加白血病复发率，并可改善无病生存期和总生存期。
