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清髓性预处理方案后采用未去除T细胞的粒细胞集落刺激因子动员外周血干细胞移植物进行单倍型相合造血干细胞移植治疗血液病:38例单中心报告

Haploidentical hematopoietic stem cell transplantation following myeloablative conditioning regimens in hematologic diseases with G-CSF-mobilized peripheral blood stem cells grafts without T cell depletion: a single center report of 38 cases.

作者信息

Lu Rui-Nan, Miao Kou-Rong, Zhang Run, Hong Ming, Xu Ji, Zhu Yu, Zhu Hua-Yuan, Qu Xiao-Yan, Wang Shuai, Wang Li, Fan Lei, Shen Wen-Yi, Lu Hua, Qiu Hong-Xia, Zhang Xiao-Yan, Chen Li-Juan, Xu Wei, Li Jian-Yong, Wu Han-Xin, Qian Si-Xuan

机构信息

Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.

出版信息

Med Oncol. 2014 Aug;31(8):81. doi: 10.1007/s12032-014-0081-x. Epub 2014 Jul 8.

Abstract

Many Chinese patients with hematologic diseases, who need allogeneic hematopoietic stem cell transplantation (HSCT), lack a human leukocyte antigen-matched donor. To save these patients and to avoid collecting donor bone marrow graft, we adopted haploidentical peripheral blood HSCT with granulocyte colony stimulating factor (G-CSF) mobilized peripheral blood stem cells as the grafts without ex vivo T cell depletion. Thirty-eight patients were enrolled, and they received myeloablative preconditioning. Thirty-five patients attained a successful neutrophil and platelet recovery. The median time for the neutrophil recovery was 16 days (range of 10-23 days), and the median time for the platelet recovery was 19 days (range of 10-66 days). During the follow-up at a median time of 33.1 weeks (range of 1.1-412.6 weeks), eleven (28.9 %) patients developed aGVHD grade I-II and seven (18.4 %) patients developed aGVHD grade III-IV. The incidence of cGVHD was 27.6 %, and nine (23.7 %) patients died within the first 100 days after transplantation. The cumulative survival proportions at 1 and 2 years were 52.51 ± 8.57 % and 43.76 ± 9.11 %, respectively. These results suggested that the G-CSF-primed peripheral blood stem cell grafts, without in vitro T cell depletion, could be an appropriate stem cell source for Haplo-HSCT.

摘要

许多需要异基因造血干细胞移植(HSCT)的中国血液病患者缺乏人类白细胞抗原匹配的供体。为了挽救这些患者并避免采集供体骨髓移植物,我们采用了单倍体相合外周血HSCT,使用粒细胞集落刺激因子(G-CSF)动员的外周血干细胞作为移植物,且不进行体外T细胞去除。38例患者入组,接受了清髓预处理。35例患者中性粒细胞和血小板成功恢复。中性粒细胞恢复的中位时间为16天(范围10 - 23天),血小板恢复的中位时间为19天(范围10 - 66天)。在中位时间为33.1周(范围1.1 - 412.6周)的随访期间,11例(28.9%)患者发生了I-II级急性移植物抗宿主病(aGVHD),7例(18.4%)患者发生了III-IV级aGVHD。慢性移植物抗宿主病(cGVHD)的发生率为27.6%,9例(23.7%)患者在移植后100天内死亡。1年和2年的累积生存率分别为52.51±8.57%和43.76±9.11%。这些结果表明,未进行体外T细胞去除且经G-CSF动员的外周血干细胞移植物可能是单倍体造血干细胞移植合适的干细胞来源。

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