急性白血病造血干细胞移植后胸壁粒细胞肉瘤复发一例并文献复习

目的 观察急性白血病造血干细胞移植(HSCT)后孤立性胸壁粒细胞肉瘤(GS)复发的临床特点.方法 回顾性分析1例急性髓系白血病(AML)患者异基因HSCT(allo-HSCT)后3年并发孤立性胸壁GS的临床资料.结果 患者胸部CT发现心膈角处肿物,经手术发现肿物原发于胸壁,切除后病理诊断为GS,经化疗以及局部放疗后治愈,目前无复发迹象,仍在定期随访中.结论 化疗联合局部放疗是治疗髓外孤立性GS的较好的方法,对于AML-HSCT的患者,需要注意髓外复发病灶的检测.     

急性髓系白血病自体造血干细胞移植后长期生存并正常生育三例

目的 探讨造血干细胞移植(HSCT)对患者生育功能的影响.方法 回3例接受自体造血干细胞移植(auto-HSCT)后长期生存并正常生育的急性髓系白血病(AML)患者的临床资料,并复习相关文献.结果 3例AML患者中,女1例,男2例,接受不含全身放疗预处理方案的auto-HSCT,分别在停止治疗后68、65和65个月生育一健康小孩.结论 育龄期接受HSCT患者的生育问题在制定治疗方案时应引起重视.     

非血缘脐血造血干细胞移植的现状

脐血是骨髓和外周血干细胞以外的新的干细胞主要来源,脐血移植特别是非血缘脐血移植( UCBT)的数量逐年增加。UCBT存在的主要问题在于脐血的造血干/祖细胞(HSC/HPC)数量少,可能导致植入延迟或植入失败。临床上采用多种方法来提高脐血HSC/HPC的数量,包括双份脐血输注、减低强度的预处理、体内体外扩增脐血细胞、同时输注单倍体血缘供者CD34+细胞或间充质干细胞( MSC)、或将脐血细胞直接注入骨髓等,取得了良好的疗效。UCBT将会成为更多患者的治疗选择。     

异基因造血干细胞移植在慢性粒细胞白血病治疗中仍有一定地位

慢性粒细胞白血病(CML)是成年人常见的白血病,我国CML的年发病率稍低于西方国家.对CML的治疗而言,酪氨酸激酶抑制剂(TKI)--伊马替尼(imatinb mesylate,IM)的问世是继白消安(myleran,busulfan)、羟基脲(hydroxyurea)、干扰素(IFN-α)、异基因造血干细胞移植(allo-BMT)之后的又一个新的里程碑[1].IM对CML的治疗取得了卓越的治疗效果,其对初治的慢性期CML血液学的缓解率达90%以上,细胞遗传学缓解率可达80%以上,甚至部分病例可获得分子学的缓解(CMoR)[2-3].     

供者外周血干细胞动员采集198例临床分析

目的 研究外周血造血干细胞移植( PBSCT)供者外周血干细胞动员采集的方法及其效 果。方法 198名健康供者每天皮下注射重组人粒细胞集落刺激因子(rhG-CSF)(5～10) μg/kg进行外周血干细胞动员,第5天开始采集。采用血细胞分析仪行单个核细胞( MNC)计数,流式细胞术(FCM)行CD34+细胞计数。分析供者性别、身高、年龄、采集当天外周血白细胞(WBC)计数对动员采集效果的影响。结果所有供者均成功动员采集,采集当天的MNC计数平均为(4.19±1.96)×108/kg,CD34+细胞计数平均为(2.98±1.40) ×106/kg; MNC和CD34+细胞计数与供者性别、身高、年龄无关;采集当天外周血WBC计数与MNC、CD34+细胞计数呈正相关(r= 0.9201,P=0.0035;r=0.8420,P= 0.0149);采集当天外周血WBC计数≥20.0×109/L的供者比＜20.0×109/L的供者采集效果更显著(F=4.688,P= 0.0013;F= 4.622,P=0.0006)。结论rhG-CSF动员的健康供者采集当天外周血WBC计数是一项预测CD34+细胞采集数量的简单、可行的指标。     

相关黏附分子在造血干细胞移植中归巢作用的研究进展

造血干细胞移植( HSCT)是治疗血液系统疾病、恶性肿瘤及部分遗传性疾病的有效方法。在HSCT过程中,造血干／祖细胞(HS/PC)归巢到造血组织是实现造血功能重建的前提。而HS／PC和骨髓基质的黏附分子(AM)对归巢起到了至关重要的作用。现在就相关AM在HSCT中归巢作用机制的研究进展作一综述。     

间充质干细胞在造血干细胞移植中的应用

间充质干细胞是一种能够从各种人成体组织分离出来的非造血多能干细胞,近年来,许多研究表明间充质干细胞具有免疫调节能力及促进组织重建等功能.就其在造血干细胞移植中的应用,如急慢性移植物抗宿主病(GVHD)、GVHD造成的移植失败、纯红细胞再生障碍性贫血及免疫性血小板减少性紫癜、出血性膀胱炎作以综述.     

非清髓性异基因造血干细胞移植后早期自然杀伤细胞的重建

目的 研究非清髓性异基因造血干细胞移植(NAST)后早期自然杀伤(NK)细胞的重建情况.方法 分别用流式细胞术直接免疫荧光法、T细胞活化实验、四甲基偶氮唑蓝比色(MTT)法检测10例NAST后白血病患者及10位健康对照者细胞表面标志及体外免疫功能.结果 移植后28～35 d,患者外周血CD+3、CD+4细胞比例降低,分别为(2.03±15.60)%和(22.69±12.29)%,CD+8细胞比例正常或增高,平均为(29.26±8.99)%;T细胞对有丝分裂原反应减低,其增殖反应刺激指数为94.60±44.87;NK细胞比例在正常范围或增高,为(18.77±9.11)%;NK细胞表面IL-2R表达阳性率增高,平均为(3.71±2.23)%,和正常对照组的(2.05±0.94)%相比差异有统计学意义(t=2.116,P=0.044);部分患者NK细胞活性明显增强,移植组与健康对照组分别为(25.30±12.39)%和(16.60±3.53)%(t=2.135,P=0.047).结论 NK细胞在NAST后早期即恢复,当特异性免疫功能仍低下时,它可能在机体抗感染和抗肿瘤中发挥着重要作用.     

巴利昔单抗在ABO血型不合造血干细胞移植中的应用

总结了对3例白血病患者进行的ABO血型不合同胞供者异基因外周血造血干细胞移植,应用巴利昔单抗加强预防GVHD(graft-versus-host disease),增加造血干细胞的输入剂量并观察其不良反应及对症护理.3例患者中,2例在应用时出现了轻微的畏寒、寒战,体温波动在37.0～37.5℃;1例出现皮疹、恶心;1例用后出现便秘;无过敏性休克、支气管痉挛、肺水肿等严重副作用的发生.3例患者造血均顺利重建,无1例发生急慢性溶血,无1例发生红系造血延迟或纯红再障,无1例需要输血,无严重急慢性GVHD的发生,无1例发生感染.认为做好充分的预防措施及严密的监测护理,能顺利完成巴利昔单抗的应用过程,增加造血干细胞的输入剂量,避免或减少ABO血型不合移植后红系造血延迟或纯红再障的发生,不增加急慢性GVHD和感染的发生率.     

VD方案联合自体造血干细胞移植治疗难治性不分泌型多发性骨髓瘤一例并文献复习

目的 观察硼替佐米+地塞米松(VD)方案联合自体造血干细胞移植(ASCT)治疗一例难治性不分泌型多发性骨髓瘤(MM)患者的疗效.方法 通过对1例难治性不分泌型MM患者给予VD方案化疗4个周期,在疾病得到有效控制、临床体征改善后,进行ASCT(预处理方案为美法仑200 mg/m2),并对国内外相关文献复习.结果 患者经过化疗达到接近完全缓解(nCR),之后联合ASCT后达到完全缓解(CR).结论 VD方案联合ASCT可明显改善难治性不分泌型MM患者的临床预后.     

Donor lymphocyte infusion for the treatment of relapse after allogeneic hematopoietic stem cell transplantation

The results of donor lymphocyte infusion (DLI) for treatment of relapse after bone marrow transplantation (BMT) are reviewed. Durable complete remission can be achieved at the molecular level for a majority (more than 70%) of patients with CML, when treated at early relapse. Results are less favourable for acute leukemias, although useful responses have been reported. Data are scarce though promising for myelodysplastic syndromes and multiple myeloma. Major treatment-associated toxicities are GVHD and bone marrow aplasia. The latter complication can be predicted by evaluating the level of residual donor-derived hematopoiesis. Modification of infused cells (CD8 negative selection or transduction with a suicide gene), addition of peripheral blood stem cells, and early implementation of escalating doses may counteract the complications and increase the response rate. Response rate is variably influenced by the presence of chronic GVHD after initial BMT, T-cell depleted BMT, underlying disease and stage at relapse, and the level of mixed chimerism. DLI is a direct demonstration of the graft-versus-leukemia effect (GVL). Because GVL after BMT is sometimes the predominant cause of cure, it may be advisable in such situations to redirect the conditioning regimens for BMT towards engraftment and less immediate cytotoxicity.     

Effectiveness of partner social support predicts enduring psychological distress after hematopoietic stem cell transplantation.

Objective: Hematopoietic stem cell transplant (HSCT) survivors who are 1 to 3 years posttransplant are challenged by the need to resume valued social roles and activities—a task that may be complicated by enduring transplant-related psychological distress common in this patient population. The present study investigated whether transplant survivors who receive adequate social support from their spouse or intimate partner experience lower distress. Method: Effects of receiving a greater quantity of partner support (a common approach to studying enacted support) were compared with effects of receiving more effective partner support (i.e., support that more closely matches their needs in terms of its quantity and quality). Men and women (N = 230) who were 1 to 3 years posttransplant completed measures of partner support quantity (Manne & Schnoll, 2001), partner social support effectiveness (Rini & Dunkel Schetter, 2010), and psychological distress (Brief Symptom Inventory; Derogatis & Spencer, 1982). Potential medical and sociodemographic confounds were controlled in analyses. Results: As hypothesized, survivors reported less distress when they received more effective partner support (p     

造血干细胞移植治疗外周T细胞淋巴瘤的进展

The general chemotherapy for Peripheral T-cell lymphoma (PTCL) featuring an active invasion has less curative effect and worse prognosis in comparison with that for B-cell non-Hodgkin's lymphoma (NHL). Studies in recent years suggest that hematopoietic stem cell transplantation (HSCT) has better curative effect on the PTCL; however, it is significant to do more studies on some aspects such as the methodology, punctuality, preconditioning, and pretreatment intensity of the transplantation, which are crucial to the curative effect.     

粒细胞集落刺激因子对供体造血干细胞移植物中树突状细胞的影响

目的 探讨粒细胞集落刺激因子(G-CSF)对正常异基因造血干细胞移植供者外周血与骨髓移植物中Ⅰ型树突状细胞(DC1)、Ⅱ型树突状细胞(DC2)的数量及DC2/DC1比例的影响.方法 以G-CSF每天10μg/kg动员5 d后,以流式细胞术(FCM)检测11例G-CSF动员的异基因外周血造血干细胞移植物及20例G-CSF动员的异基因骨髓移植物中的DC1、DC2数量及DC2/DC1比例,并与8例正常供者动员前外周血及10例健康者动员前骨髓进行比较.结果 动员前后骨髓DC2由14.37×106/L增至29.68×106/L(t=2.433,P=0.022),而骨髓DC1分别为13.77×10a/L和18.88×106/L(t=0.625,P=0.541);DC2/DC1比例在动员后为1.83±0.81,较动员前的1.12±0.32明显升高(t=2.685,P=0.013).正常供者以G-CSF动员前、后移植物中外周血DC2数量分别为14.92×106/L和26.76×106/L(t=2.390,P=0.029),DC2/DC1比例分别为1.00±0.37和2.02±1.43(t=2.158,P=0.044),但外周血DC1分别为14.21×106/L和18.02×106/L(t=0.625,P=0.541).结论 移植前以G-CSF动员正常异基因干细胞移植供者,可选择性提高外周血及骨髓移植物中DC2的数量,而DC1数量无明显增加.     

Infusion of donor peripheral blood mononuclear cells to treat relapse after transplantation for chronic myelogenous leukemia

Until recently, the only curative therapy for patients with chronic myelogenous leukemia (CML) who relapse after allogeneic bone marrow transplantation (BMT) has been second allogeneic BMT. Recently, donor mononuclear cells have been given to patients with relapsed CML to induce a potent graft-versus-leukemia reaction and re-establish complete remissions in the majority of patients without the need for a second transplant. The extraordinary success of donor mononuclear cell infusions shows that it is possible to manipulate and harness the graft-versus-leukemia (GVL) reaction for clinical benefit. The identity of the effector cells and target antigens is unclear, but intensive investigation is beginning to define the complex cytokine and cellular interactions that mediate GVL reactivity. Current clinical trials are investigating strategies that will retain and enhance the GVL effects while limiting toxicity from this therapy. Ultimately, the ability to harness the GVL potential of allogeneic donor cells without excessive toxicity from graft-versus-host disease will be a central challenge in BMT and cellular immunotherapy.