BONE MARROW TRANSPLANTATION FOR SEVERE APLASTIC ANEMIA—A STUDY OF TWENTY‐ONE CHINESE PATIENTS IN TAIWAN
BONE MARROW TRANSPLANTATION FOR SEVERE APLASTIC ANEMIA—A STUDY OF TWENTY‐ONE CHINESE PATIENTS IN TAIWAN
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骨髓移植治疗严重再生障碍性贫血——对台湾 21 名中国患者的研究
DOI：
10.1097/00007890-199203000-00015
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发表时间：
1992
期刊：
影响因子：
6.2
通讯作者：
Po
中科院分区：
文献类型：
--
作者：
C. Tzeng;R. Hsieh;S. Fan;Jin;Jacqueline M. Liu;Chia;Kuang Y. Chen;C. Yung;Shengchuan Wang;Soo‐Ray Wang;T. Chiou;Po
1985年3月至1990年9月间，共对21例多次输血的重型再生障碍性贫血（SAA）患者进行了骨髓移植治疗，其中20例为异基因骨髓移植，1例为同基因骨髓移植。7例同种异体移植受者混合淋巴细胞培养（MLC）也呈阳性反应。移植前预处理包括连续4天高剂量环磷酰胺（CY）200 mg/kg，然后在BMT前一天进行300 cGy全身照射。17例年龄大于14岁的患者在移植后5天接受了额外的供体血沉棕黄层细胞输注。甲氨蝶呤和环孢素的组合用于预防移植物抗宿主病。17例患者存活，移植物功能正常，Kaplan-Meier乘积极限估计显示67.7个月时的生存概率为80.95%。有4例死亡：2例死于原发性移植失败，1例死于继发性排斥反应，另1例死于慢性GVHD相关并发症。仅1例患者（5.6%）发生急性GVHD，I级。与此相反，慢性GVHD观察到10/18（55.6%）可评估的患者。未诊断出静脉闭塞性肝病和间质性肺炎。我们的研究结果表明，CY/TBI/BC组合耐受性良好，在多次输血的中国SAA移植患者中移植失败/排斥反应的发生率较低。MTX/CsA联合治疗可显著降低急性GVHD的发生率和严重程度。对于40岁以下的SAA患者，如果有HLA相同的兄弟姐妹，我们强烈推荐BMT作为治疗的选择。
A total of 21 multiply transfused patients with severe aplastic anemia (SAA) were treated with bone marrow transplantation between March 1985 and September 1990: 20 allogeneic and one syngeneic transplants. A positive response in mixed lymphocyte culture (MLC) was also noted in 7 allogeneic recipients. Pregraft conditioning included high-dose cyclophosphamide (CY) 200 mg/kg over 4 consecutive days, followed by 300 cGy total-body irradiation the day before BMT. Seventeen patients older than 14 years received additional donor buffy-coat cells infusion for 5 days posttransplant. A combination of methotrexate and cyclosporine was used for prophylaxis of graft-versus-host disease. Seventeen patients were alive with a functional graft, and Kaplan-Meier product limit estimates showed a 80.95% probability of survival at 67.7 months. There were 4 deaths: two died of primary graft failure, one from secondary rejection, and the other from chronic GVHD-related complications. Acute GVHD, grade I was noted in only one patient (5.6%). In contrast, chronic GVHD was observed in 10 out of 18 (55.6%) evaluable patients. Venoocclusive liver disease and interstitial pneumonitis were not diagnosed. Our findings indicate that the combination of CY/TBI/BC is well tolerated and results in a low incidence of graft failure/rejection in multiply transfused Chinese patients who received transplants for SAA. The MTX/CsA combination was confirmed as being remarkable in reducing the incidence and severity of acute GVHD. For patients with SAA under the age of 40, with an HLA-identical sibling, we highly recommend BMT as the treatment of choice.