异基因造血干细胞移植后肠道急性移植物抗宿主病24例临床分析

摘要

目的 观察异基因造血干细胞移植术后肠道急性移植物抗宿主病(aGVHD)的临床特征、治疗及转归.方法 24例患者中7例接受同胞间白细胞抗原(HLA)全相合造血干细胞移植、17例接受HLA半相合造血干细胞移植,预处理方案依据具体情况选择FBA(氟达拉滨、白消安、阿糖胞苷)、Bu/Cy(白消安/环磷酰胺)、CCNU+Bu+CTX(环磷酰胺)+Ara-c(阿糖胞苷)+ATG、IFBA(伊达比星、氟达拉滨、白消安、阿糖胞苷)+ATG方案,采用环孢素A(CsA)联合短疗程甲氨蝶呤(MTX)及吗替表考芬兮酯(MMF)预防GVHD.结果 24例患者发生肠道aGVHD的中位时间为移植后24 d,Ⅲ度aGVHD 2例,Ⅳ度aGVHD 22例;经治疗,15例患者症状缓解,9例疗效欠佳.结论 肠道aGVHD临床症状重,预后差,需早期诊断及治疗.%Objective To investigate the feature, treatment and outcome of severe intestinal acute graft-versus-host disease (aGVHD) after allogeneic hemapoietic stem cell transplantation(Allo-HSCT). Methods Seven patients received PBSCT from their HLA matched haploidentical siblings and seventeen patients received PBSCT/BMT from their HLA dismatched unrelated donors or haploidentical siblings or other relative. Twenty-four patients were pre-conditioned by different regimen which was determined on a case-by-case basis. The prevention of acute graft-versus-host disease (aGVHD) included cyclosporin A (CsA), mycophenlate mofetil (MMF) ,and short course of methotrexate (MTX). Results Twenty-four patients developed intestinal aGVHD including two cases with grade Ⅲ and twenty two cases with grade Ⅳ ,and the mean time of aGVHD development was 24 days after Allo-HSCT.The symptoms of fifteen patients were relieved while that of nine patients unrelieved after treatment. Conclusion Patients with in testinal aGVHD have serious symptoms and poor prognosis. The early diagnose and treatment are necessary for intestinal aGVHD after transplantation.