甲基泼尼松龙分层治疗非血缘脐血移植植入前综合征的疗效观察

目的: 研究甲基泼尼松龙（MP）分层治疗非血缘脐血造血干细胞移植（UCBT）患者植入前综合征（PES）的疗效及对UCBT结果的影响。方法: 回顾性分析自2012年11月至2015年3月于本中心接受UCBT的8例恶性血液病患者，其中单份UCBT 7例，双份UCBT 1例；急性髄系白血病4例，急性淋巴细胞白血病4例。所有患者均采用强化清髓方案行移植前预处理，其中采用分次全身照射（sTBI）7例，非sTBI 1例。PES采用MP分层治疗，预防移植物抗宿主病（GVHD）方案均采用环孢素A（CsA）联合短程霉酚酸酯（MMF），随访截止日期为2016年8月31日。结果: 8例UCBT患者移植早期均发生PES，PES累积发生率为100%。发生PES时C反应蛋白（CRP）峰值明显高于预处理阶段、PES控制后及发生Ⅱ～Ⅳ度急性GVHD（aGVHD）时的CRP水平（P<0.05），接受MP 0.5 mg·kg^-1·d^-1及MP1 mg·kg^-1·d^-1治疗的患者两组间无统计学差异（P均＞0.05），采用MP治疗PES疗效确切。接受甲基泼尼松龙分层治疗的患者在中性粒细胞、血小板累积植入率及Ⅱ～Ⅳ度急性GVHD、Ⅲ～Ⅳ度aGVHD累积发生率上差异均无统计学意义（P均＞0.05）。8例患者UCBT后100 d均发生感染，其中细菌感染率75%，巨细胞病毒(CMV)血症发生率100%；无EB病毒(EBV)感染；接受MP 0.5 mg·kg^-1·d^-1治疗组细菌感染发生率50%，MP 1 mg·kg^-1·d^-1治疗组为100%，两组患者感染发生率上无统计学差异（P均＞0.05）。至随访截止，总生存期（OS）及总复发率均无统计学差异（P均＞0.05）。结论: UCBT后PES发生率较高，MP对UCBT后PES的治疗效果确切，且根据患者PES症状严重程度进行MP分层治疗可能减少患者感染等移植并发症，提高患者UCBT的移植疗效，延长患者生存。

Effect of risk adjustment methylprednisolone intervention on the prognosis of pre-engraftment syndrome after unrelated cord blood transplantation

AIM: To retrospectively study the effect of risk adjustment methylprednisolone (MP) intervention on the prognosis of pre-engraftment syndrome (PES) and impacts on outcomes after unrelated cord blood transplantation (UCBT). METHODS: The data of 8 patients with acute leukemia underwent single or double UCBT from November 2012 to March 2015 were analyzed in this study, including 7 single UCBT and 1 double UCBT, half of the patients were acute lymphoblastic leukemia, and the other 4 patients were acute myeloid leukemia. All the patients were received intensified myeloablative conditioning, including 7 sTBI-based conditioning and one based on Flu. Treatment with risk adjustment methylprednisolone was given to all the patients for PES intervention. And for graft-versus-host disease (GVHD) prophylaxis, a combination of cyclosporine (CsA) and mycophenolate mofetil (MMF) was given. The cohort of patients were followed-up till to August 31, 2016. RESULTS:All the patients showed PES after UCBT and the incidence of PES was 100%. When compared the maximum C-reactive protein(CRP) level, the median value during PES was significantly higher than the serum level during conditioning therapy, after PES and the onset of II-IV acute GVHD (all P<0.05, respectively), and the result of patients received different doses of MP (0.5 mg·kg^-1·d^-1 and 1mg·kg^-1·d^-1) showed no significant difference (P>0.05). Treatments based on different doses of MP showed a good clinical effect on PES, and there was no significant difference on transplant-related complications such as cumulative incidences of neutrophil engraftment, platelet recovery, II-IV and III-IV acute GVHD (all P>0.05, respectively). What's more, all the patients experienced infections in 100 days after UCBT. The incidence of bacterial infection was 75%, and the incidence of CMV infection was 100%. But in this study, no one experienced EBV infection after UCBT. In patients received MP 0.5mg·kg^-1·d^-1, the incidence of bacterial infection was 50%, but it was 100% in those received MP 1mg·kg^-1·d^-1. No significant difference was found between the 2 groups not only in infection, but also in the incidences of overall survival (OS) and relapse (P>0.05). CONCLUSION: PES seems to be common after UCBT, and MP is an effective intervention. Different doses of MP therapy based on the clinical manifestations of PES cases do not influence the results of UCBT in this cohort. Furthermore this approach can reduce patient transplant complications, improve the outcomes of UCBT and prolong the survival of patients underwent UCBT.