Klein J L, Avalos B R, Belt P, Taylor C A, Ezzone S A, Scholl M D, Fisher J, Young D, Copelan E A
Division of Bone Marrow Transplantation, Arthur G James Cancer Hospital and Research Institute, Ohio State University, Columbus, USA.
Bone Marrow Transplant. 1996 Apr;17(4):479-83.
Two major problems of unrelated donor transplantation have been an increased incidence of GVHD and graft failure. Even with HLA identity by microlymphocytotoxicity assay and non-reactive MLC, URD marrow transplant recipients have a higher incidence of graft rejection and GVHD. The preparative regimen busulfan 16 mg/kg and cyclophosphamide 120 mg/kg (BuCy2) has been shown to be at least as effective in preparation of recipients with CML of HLA-identical sibling grafts as cyclophosphamide and total body irradiation (Cy/TBI). However, concern about a high rejection rate in URD transplants has prevented most centers from using BuCy2 in this setting. From March 1990 to March 1994, 26 patients underwent URD transplantation following preparation with BuCy2. Patients received either standard cyclosporine and methotrexate or cyclosporine and methylprednisolone for GVHD prophylaxis. Two patients died on day 16 and 20 without evidence of hematopoietic engraftment. Of the 24 patients evaluable for engraftment, 23 (96%) had evidence of donor engraftment defined as an ANC > 0.5 x 10(9)/1. No patient who had initial engraftment had late graft failure. Within our study group the risk of graft rejection or graft failure does not appear to be higher than that reported for URD transplants utilizing TBI-containing regimens.
非血缘供者移植的两个主要问题是移植物抗宿主病（GVHD）发病率增加和移植物失败。即使通过微量淋巴细胞毒性试验和无反应性混合淋巴细胞培养（MLC）实现了人类白细胞抗原（HLA）匹配，非血缘供者骨髓移植受者的移植物排斥和GVHD发病率仍较高。已证明，预处理方案白消安16mg/kg和环磷酰胺120mg/kg（BuCy2）在预处理慢性粒细胞白血病（CML）患者以接受HLA匹配的同胞移植物方面，至少与环磷酰胺和全身照射（Cy/TBI）一样有效。然而，由于担心非血缘供者移植中的高排斥率，大多数中心在这种情况下未使用BuCy2。1990年3月至1994年3月，26例患者在接受BuCy2预处理后接受了非血缘供者移植。患者接受标准环孢素和甲氨蝶呤或环孢素和甲基泼尼松龙预防GVHD。两名患者分别在第16天和第20天死亡，无造血植入证据。在可评估植入情况的24例患者中，23例（96%）有供者植入证据，定义为中性粒细胞绝对值（ANC）>0.5×10⁹/L。所有初始植入的患者均未发生晚期移植物失败。在我们的研究组中，移植物排斥或移植物失败的风险似乎并不高于使用含全身照射方案的非血缘供者移植报告的风险。
