自体骨髓移植联合MHC单倍体相合淋巴细胞治疗急性髓性白血病的临床疗效
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摘要
目的:自体骨髓移植联合MHC单倍体相合淋巴细胞治疗急性髓性白血病的治疗效果和安全性。方法:以40例急性髓性白血病患者作为研究对象,随机分为两组各20例,研究组患者使用自体骨髓移植联合MHC单倍体相合淋巴细胞进行治疗,对照组单用自体骨髓移植进行治疗。结果:两组患者的造血系统都得到重建,重建时间以及并发症的发生均没有显著差异。而研究组患者复发率显著降低,且复发时间明显地长于对照组患者。研究组患者3年累积无病生存率明显地高于对照组患者,且差异具有统计学意义。结论:自体骨髓移植联合MHC单倍体相合淋巴细胞治疗能够有效控制急性髓性白血病病情,降低其复发,延长患者生存期。
Objective:To investigate the clinical effect and safety of autologous bone marrow transplantation combined with MHC haploidentical immune cells in the treatment of leukemia.Methods:40 patients with leukemia were randomly divided into two groups,20 patients in each group.The patients in the study group were treated with autologous bone marrow transplantation combined with MHC haploidentical immune cells,and the control group was treated with autologous bone marrow transplantation alone.Results:There was no significant difference between the two groups in the reconstitution of hematopoietic system,the time of reconstruction and the occurrence of complications.The recurrence rate of the study group was significantly decreased,and the recurrence time was significantly higher than that of the control group.The 3-year cumulative disease free survival rate of the study group was significantly higher than that of the control group,and the difference was statistically significant.Conclusion:Autologous bone marrow transplantation combined with MHC haploidentical immune cell therapy can effectively control leukemia,reduce the recurrence of leukemia,and prolong the survival time of patients.
Objective:To investigate the clinical effect and safety of autologous bone marrow transplantation combined with MHC haploidentical immune cells in the treatment of leukemia.Methods:40 patients with leukemia were randomly divided into two groups,20 patients in each group.The patients in the study group were treated with autologous bone marrow transplantation combined with MHC haploidentical immune cells,and the control group was treated with autologous bone marrow transplantation alone.Results:There was no significant difference between the two groups in the reconstitution of hematopoietic system,the time of reconstruction and the occurrence of complications.The recurrence rate of the study group was significantly decreased,and the recurrence time was significantly higher than that of the control group.The 3-year cumulative disease free survival rate of the study group was significantly higher than that of the control group,and the difference was statistically significant.Conclusion:Autologous bone marrow transplantation combined with MHC haploidentical immune cell therapy can effectively control leukemia,reduce the recurrence of leukemia,and prolong the survival time of patients.
引文
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[14] Ullah MA,Hill GR,Tey SK.Functional reconstitution of natural killer cells in allogeneic hematopoietic stem cell transplantation[J].Frontiers in Immunology,2016,7(21):144.
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[16] He Juan,Zhai Ming.The relationship between lymphoma after auto-bone marrow transplantation and autoimmune disease[J].Journal of Leukemia & Lymphoma,2008,17(04):281.[何娟,翟明.自体骨髓移植治疗淋巴瘤合并自身免疫性疾病的探讨[J].白血病·淋巴瘤,2008,17(04):281.]
[17] Liu Yaping.Laboratory diagnosis and clinical analysis of 105 children with acute leukemia[J].Jilin Medical Journal,2007,28(13):1506.[刘亚萍.儿童急性白血病105例实验室诊断及临床分析[J].吉林医学,2007,28(13):1506.]
[18] Aversa F.Haploidentical haematopoietic stem cell transplantation for acute leukaemia in adults:Experience in Europe and the United States[J].Bone Marrow Transplant,2008,41:473-481.
[2] Muroi K,Miyamura K,Okada M,et al.Bone marrow-derived mesenchymal stem cells (JR-031) for steroid-refractory grade III or IV acute graft-versus-host disease:A phase II/III study[J].International Journal of Hematology,2016,103(2):243-250.
[3] Le Blanc K,Frassoni F,Ball L,et al.Mesenchymal stem cells for treatment of steroid-resistant,severe,acute graft-versus-host disease:A phase II study[J].Lancet,2008,371:1579-1586.
[4] Zheng Meiling,Pan Feifei,Feng Qiangwei,et al.Investigation and analysis of the cognition of bone marrow donation by medical staff in Huzho[J].Jilin Medical Journal,2010,31(33):6035-6036.[郑美玲,潘飞飞,冯蔷薇,等.湖州市医护人员对骨髓捐献的认知度调查与分析[J].吉林医学,2010,31(33):6035-6036.]
[5] Liu Hui,Chang Naibai,Gu Xichun,et al.Autologous stem cell transplantation for the treatment of adult acute leukemia[J].J Clin Hematol,2009,22(1):24.[刘辉,常乃柏,顾惜春,等.自体造血干细胞移植治疗急性白血病的临床观察[J].临床血液学杂志,2009,22(1):24.]
[6] Qin XY,Wang Y,Li GX,et al.CTLA-4 polymorphisms and haplotype correlate with survival in ALL after allogeneic stem cell transplantation from related HLA-haplotype-mismatched donor[J].Journal of Translational Medicine,2016,14(1):1-11.
[7] Wang Jingbo,Da Wanming,Zhang Jianping,et al.Successful treatment of high risk/refractory leukemia by tumor-ablative individualized conditioning allogeneic hematopoietic stem cell transplantation[J].Chin J Hematol,2010,31(8):505-509.[王静波,达万明,张建平,等.强烈预处理异基因造血干细胞移植治疗高危难治性白血病[J].中华血液学杂志,2010,31(8):505-509.]
[8] Gao L,Liu J,Zhang Y,et al.Low incidence of acute graft-versus-host disease with short-term tacrolimus in haploidentical hematopoietic stem cell transplantation[J].Leukemia Research,2017,57:27-36.
[9] Guo M,Sun Z,Sun QY,et al.A modified haploidentical nonmyeloablative transplantation without T cell depletion for high-risk acute leukemia:Successful engraftment and mild GVHD[J].Biol Blood Marrow Transplant,2009,15:930-937.
[10] Jing Yu,Yu Li,Liu Haichuan,et al.Autologous hematopoietic stem cell transplantation for treatment of 77 patients with acute myelogenous leukemia[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2008,12(47):9297.[靖彧,于力,刘海川,等.自体造血干细胞移植治疗急性髓系白血病77例[J].中国组织工程研究与临床康复,2008,12(47):9297.]
[11] Von Dalowski F,Kramer M,Wermke M,et al.Mesenchymal stromal cells for treatment of acute steroid-refractory graft versus host disease:Clinical responses and long-term outcome[J].Stem Cells,2016,34(2):357-366.
[12] Lu Daopei,Wu Tong,Gao Zhiyong,et al.Significantly reduce acute graft-versus-host disease in haploidentical stem cell transplantation by using cord blood as the third party cells[J].Blood(ASH Annual Meeting Abstracts),2008,112:2211.
[13] Chen Yancai,Qu Min,Lu Changyou,et al.1 case of chronic myeloid leukemia after 10 years of autologous bone marrow transplantation in ALL[J].Chinese Medical Journal of Metallurgical Industry,2009,26(6):628.[陈艳才,屈敏,卢昌友,等.ALL自体骨髓移植术后10年发生慢性髓细胞白血病1例[J].中国冶金工业医学杂志,2009,26(6):628.]
[14] Ullah MA,Hill GR,Tey SK.Functional reconstitution of natural killer cells in allogeneic hematopoietic stem cell transplantation[J].Frontiers in Immunology,2016,7(21):144.
[15] Koh LP,Rizzieri DA,Chao NJ.Allogeneic hematopoietic stem cell transplant using mismatched/haploidentical donors[J].Biol Blood Marrow Transplant,2007,13:1249-1267.
[16] He Juan,Zhai Ming.The relationship between lymphoma after auto-bone marrow transplantation and autoimmune disease[J].Journal of Leukemia & Lymphoma,2008,17(04):281.[何娟,翟明.自体骨髓移植治疗淋巴瘤合并自身免疫性疾病的探讨[J].白血病·淋巴瘤,2008,17(04):281.]
[17] Liu Yaping.Laboratory diagnosis and clinical analysis of 105 children with acute leukemia[J].Jilin Medical Journal,2007,28(13):1506.[刘亚萍.儿童急性白血病105例实验室诊断及临床分析[J].吉林医学,2007,28(13):1506.]
[18] Aversa F.Haploidentical haematopoietic stem cell transplantation for acute leukaemia in adults:Experience in Europe and the United States[J].Bone Marrow Transplant,2008,41:473-481.