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| 未经体外去除T细胞的人类白细胞抗原配型不相合/单倍体相合造血干细胞移植：改善加速期和急变期慢性粒细胞白血病患者的预后 |
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| HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: Improved outcomes in patients in accelerated phase and blast crisis phase |
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| Xiao-Jun H., Lan-Ping X., Kai-Yan L., Dai-Hong L., Huan C., Wei H., Yu-Hong C., Jing-Zhi W., Yao C., Xiao-Hui Z., Hong-Xia S., Dao-Pei L. 2009/5/29 18:39:20 |
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Annals of Medicine, 2008, Volume 40, Issue 6
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| Background. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only proven curative therapy for chronic myeloid leukemia (CML), but lack of human leukocyte antigen (HLA)-matched sibling or unrelated donors has restricted its application. Recently, we developed an effective method for haploidentical allo-HSCT achieving comparable outcomes to HLA-identical transplantation. Aim. To evaluate the outcomes of CML patients who underwent haploidentical allo-HSCT. Methods. Ninety-three patients were treated with a modified busulfan(BU)/cyclophosphamide (CY)2 regimen, including antithymocyte globulin followed by unmanipulated blood and marrow transplantation. Results. Our data showed that the cumulative incidence of acute graft-versus-host disease (GVHD) was 64.52%, and grade III-IV was 26.45%, 61.79% had chronic GVHD, and 28.93% had extensive chronic GVHD. Non-relapse mortality varied at 8.72% (100 days), 20.72% (1 year) and 20.72% (2 years). Probability of 1-year and 4-year leukemia-free survival was similar in chronic phase (CP) 1, CP2/CR2, accelerated phase, and blast crisis patients. Probability of 4-year overall survival varied as 76.5% (CP1), 85.7% (CP2/CR2), 73.3% (accelerated phase), and 61.5% (blast crisis). Multivariate analysis indicated that factors affecting transplantation outcomes were HLA-B+DR mismatches versus others for II-III acute GVHD and III-IV acute GVHD, the stage of disease at transplantation for relapse, and the time from diagnosis to transplantation for leukemia-free survival, overall survival, and transplantation-related mortality. In our protocol, survival of HSCT for advanced CML was similar to stable stage. Conclusions. For patients lacking an HLA-identical related donor, haploidentical relatives are alternative HSCT donors. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS). |
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| Correspondence Address: Xiao-Jun, H.; Peking University Institute of Hematology, 11 South Street of Xizhimen, Xicheng District, Beijing, 100044, China; email: xjhrm@medmail.com.cn |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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