Spousal hematopoietic stem cell transplantation.
Spousal hematopoietic stem cell transplantation.
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配偶造血干细胞移植。
DOI：
10.1007/s12185-016-2168-y
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Okada M et al.,
中科院分区：
文献类型：
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作者：
Ikegame K;Okada M et al.,
我们报道了一组试验性的5例患者，他们接受了来自配偶的干细胞移植(SCT)，原因是移植后复发或排斥。关于人类白细胞抗原差异的纳入标准是在人类白细胞抗原-A、B和DR基因座的移植物抗宿主方向上有三个或更少的抗原不匹配。四名患者接受了配偶SCT，作为移植后复发后的第三次移植尝试，一名患者作为移植排斥反应的挽救。低强度预适应(RIC)方案包括氟达拉滨、马法兰和抗胸腺细胞球蛋白(ATG)，复发病例采用3Gy全身照射(TBI)，排斥病例采用ATG+4GyTBI。移植物抗宿主病(GVHD)的预防包括他克莫司、甲基强的松龙和霉酚酸酯。移植外周血干细胞。所有病例在第9天至第11天(中位数为10天)实现了粒细胞植入，并伴有完全的配偶嵌合体。在5名患者中，有3名患者没有观察到急性GVHD，1名患者发展为III级GVHD，1名患者出现IV级GVHD。所有4名可评估抗白血病效果的患者均获得完全缓解；然而，所有患者在移植后106天至334天之间复发，并在152天至548天之间死亡。我们建议，配偶SCT可以作为一种重复的SCT，使用RIC方案结合小剂量的ATG和含类固醇的GVHD预防。
We report a pilot series of five patients who received stem cell transplantation (SCT) from a spouse for post-transplant relapse or rejection. The inclusion criterion regarding HLA disparities was three or fewer antigen mismatches in the graft-versus-host direction at the HLA-A, B, and DR loci. Four patients received spousal SCT as a third transplant attempt after post-transplant relapse and one as rescue for graft rejection. The reduced intensity conditioning (RIC) regimen consisted of fludarabine, melphalan, and anti-thymocyte globulin (ATG) with 3 Gy of total body irradiation (TBI) for relapse cases and ATG plus 4 Gy of TBI for the rejection case. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. Peripheral blood stem cells were transplanted. Granulocyte engraftment was achieved in all cases between days 9 and 11 (median, 10) with complete spousal chimerism. In three of the five patients, no acute GVHD was observed, while one case developed grade III GVHD and one case grade IV. All four patients evaluable for the anti-leukemic effect achieved complete remission; however, all relapsed between 106 and 334 day post-transplant, and died between days 152 and 548. We suggest that spousal SCT can be performed as a repetitive SCT using a RIC regimen with low-dose ATG and steroid-containing GVHD prophylaxis.