HLA匹配同胞供者异基因造血干细胞移植治疗重型再生障碍性贫血41例疗效分析

Objegtive To evaluate the eficacy of allogeneic hematopoietic stem cell transplantation from HLA- matched siblings（MSD allo-HSCT） for severe aplastic anemia (SAA)．Methods Retrospective analysis the clinical data of forty-one SAA patients received MSD allo-HSCT from 2003.5 to 2011.8.31,twenty-eight patients suffered from SAA-I，nine patients suffered from SAA-II, four patients suffered from aplastic anemia post-hepatitis，median age is 23(5-43)years old,seventeen patients conducted allogeneic bone marrow transplantation(allo-BMT), twenty-four patients conducted allogeneic peripheral blood stem cell transplantation(allo-PBSCT),20 patients'conditioning regimen was CY+ATG+Flu, 21 patients'conditioning regimen was CY+ATG+Flu±Bu/Mel, 25 paitents'GVHD preventing regimen was CSA+MTX,16 paitents' GVHD preventing regimen was FK506+MTX,the median reinfusion quantity of CD34+ was 3.48(2.39 -4.8)×106/kg in allo-BMT and 2.95(1.27-5.98)×106/kg in allo-PBSCT. Resuits Hematopoiesis reconstitution was achieved in all 41 patients(100％ )．The median time of neutrophils reached to 0.5×l09／L and platelets reached to 20×109／L were 14（10-23）days and 19（8-38）days，respectively．12 patients developed acute graft-versus-host diseaes(aGVHD)，all out of them, 11 patients developed grade I-II aGVHD，one patients developed grade IV aGVHD，two patients occurred chronic GVHD( cGVHD),one with local cGVHD and the other one with widely cGVHD． Graft rejection(GR) was occurred in 4 patients, all 4 patients recovery haemopoietic and survival with donor peripheral blood stem cell infusion．5 patients died（18.9% ±9.0%）,oen patients died of widely cGVHD,4 patients died of invasive fungal infections. Median follow-up time was 23(3-79) months. 36 patients survive，and prospective OS is 81.1％ ±9.0％.Univariate analysis showed that five factors can reduce OS, including conducted PBSCT,occurrence of aGVHD, infusion quantity of CD34+ cells no more than 2.5×106/kg ,the number of blood transfusion befor transplantation more than 30u and occurrence of invasive fungal infections after transplantation（P=0.034,0.001,0.006,0.000, 0.001） ；four factors were related with occurrence of aGVHD, including the difference of donor and recipient's ABO blood group, the number of platelet transfusion befor transplantation more than 100u, the number of blood transfusion befor transplantation more than 30u ,infusion quantity of CD34+ no more than 2.5×106/kg（P=0.019, 0.038,0.005,0.005）；the number of platelet transfusion befor transplantation more than 100u was related with occurrance of GR（P=0.038）. Conclusion MSD allo-HSCT is an effective therapy for patients with SAA. Reducing the number of blood transfusion befor transplantation, using bone marrow transplantation，increasing infusion quantity of CD34+ cells，effective prevention and treatment of aGVHD and invasive fungal infections after transplantation may improve the eficacy of MSD allo-HSCT for SAA.