父母供子女单倍型造血干细胞移植治疗恶性血液病疗效分析

Effects of Parental Donor in Haploidentical Hematopoietic Stem Cell Transplantation on Hematologic Malignancies

作者: 专业:内科学 导师:万鼎铭 年度:2013 学位:硕士  院校: 郑州大学

Keywords

Hematopoietic stem cell, haploidentical, donor, gender, graft-versus-host disease, modified Bu/Cy, hematologic malignancies, stem celltransplantation

        背景及目的单倍型造血干细胞移植是治愈恶性血液病的一种有效方法,合适的供者及快速查找到合适的供者有助于提高移植的成功率。比较父母供子女单倍型造血干细胞移植治疗恶性血液病的临床疗效。资料与方法回顾性分析2006年8至2012年6月在郑州大学第一附属医院行父母为供者的单倍型造血干细胞移植治疗的92例恶性血液病患者,分为父供子移植(A组)、父供女移植(B组)、母供子移植(C组)、母供女移植(D组)4组,所有患者的预处理方案均为“改良Bu/Cy+ATG’’预处理方案,应用“环孢素A(CsA)+吗替麦考酚酯(MMF)+短程甲氨蝶呤(MTX)”预防移植物抗宿主病(GVHD)的发生。随访观察至2012年9月,对比4组患者造血重建时间、移植物抗宿主病的发生率、复发率、2年无病生存率及2年总生存率等。应用统计软件SPSS17.0进行统计学分析,检验水准a=0.05。结果92例患者均完全植入并获得造血重建,4组急性移植物抗宿主病发生率慢性移植物抗宿主病发生率和复发率差异无显著性意义(P>0.05)。但4组Ⅲ、Ⅳ度急性移植物抗宿主病发生率、2年无病生存率、2年总生存率差异有显著性意义(P<0.05)。其中父供子移植组、母供女移植组的Ⅲ、Ⅳ度急性移植物抗宿主病发生率低于父供女移植组和母供子移植组;同时父供子移植组和母供女移植组的2年无病生存率、2年总生存率高于父供女移植组和母供子移植组。结论1父母供子女单倍型造血干细胞移植是安全可行的。2.单倍型造血干细胞移植中,供受者性别相同比供受者性别不同的疗效好。
    Background and ObjectiveThe haploidentical hematopoietic stem cell transplantation (HSCT) is an effective treatment of hematologic malignancies. It is very useful for increasing the successful rate of stem cell transplantation to search an appropriate donor rapidly.Observe and compare the effect of parental to offspring grafts on the treatment of the haploidentical hematopoietic stem cell transplantation in hematologic malignancies.Materials and MethodsWe retrospectively analyzed outcomes in92patients with hematologic malignancies who underwent parental haploidentical hematopoietic stem cell transplantation were divided into four groups including father-to-son transplantations(groupA), father-to-daughter transplantations (groupB), mother-to-son transplantations (group C) and mother-to-daughter transplantations (group D) in the first affiliated hospital of zhengzhou university from August,2006to June,2012. The four groups were analysed in the incidence of graft versus host disease (GVHD), recurrence rate, and2-year diseases free survival and overall survival.By using SPSS17.0to analysis, the value less than0.05was considered as significance.ResultsEngraftment was successful in a total of92patients.The severe acute GVHD and chronic GVHD and the relapse of malignant diseases were similar in the four groups (P>0.05). Significant difference was observed in the occurrence of Ⅲ-Ⅳ aGVHD and2-year diseases free survival (DFS) and2-year overall survival rate(OS) among four groups (P<0.05). The incidence of Ⅲ-Ⅳ aGVHD in father-to-son grafts and mother-to-daughter grafts was significantly lower than in father-to-daughter grafts and mother-to-son grafts. Father-to-son grafts and mother-to-daughter grafts had a significantly higher2-year DFS and OS, as compared with father-to-daughter grafts and mother-to-son grafts.Conclusion1The parental to offspring grafts is safe and feasible.2The same gender of patients and donors have better effect than the different gender of patients and donors in parental to offspring grafts.
        

父母供子女单倍型造血干细胞移植治疗恶性血液病疗效分析

摘要4-6
Abstract6-7
英文縮略词表9-11
1 引言11-13
2 资料与方法13-18
3 结果18-22
4 讨论22-27
5 结论27-28
参考文献28
综述部分28-50
    造血干细胞移植供者的选择32-46
    参考文献46-50
个人简历及在学期间发表的学术论文50-51
致谢51
        下载全文需58


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