| BACKGROUND: With the optimization of transplantation scheme and the emergence of graft-versus-host disease(GVHD)therapy drugs,allo-HSCT has obtained great progress,so that patients with malignant hematological diseases has improved the quality of life and the chance to cure the disease.At present,allo-HSCT has become the first choice for young patients with severe aplastic anemia(SAA),however,since our country has adopted a policy of family planning for many years,many patient are from one-child families,lack of sibbling-matched donors(MSD).Therefore,the study of haploid and unrelated donor allo-HSCT provides a new choice for the treatment of SAA patients,especially Haplo transplantation.OBJECTIVE: To compare the efficacy and safety of three types of allo-HSCT used in the treatment of severe aplastic anemia patients.METHODS: A total of 48 patients with severe aplastic anemia who received allo-HSCT from November 2005 to November 2017 were reviewed.Including 9 cases of haploidentical donor transplantation,10 cases of unrelated donor transplantation,29 cases of sib-matched donor transplantation.In 48 patients,34 cases had severe aplastic anemia and 14 cases had very severe aplastic anemia.Stem cells were derived from bone marrow and peripheral blood.In order to evaluate the different stem cell derived stem cells(allo-HSCT)in severe aplastic anemia(SAA)effect and influencing factors of treatment,compare the hematopoietic reconstitution after transplantation,graft-versus-host disease(GVHD)incidence rate and 5 year survival rate(OS)and its influencing factors.Pretreatment scheme: cyclophosphamide(CY)+ anti-human thymocyte globulin(ATG)+ fludarabine(Flu)24 cases,CY+Flu+ Total Boday Irradiation(TBI)7 cases.CY+ATG 7 cases,CY+ATG+Flu+TBI 9 cases.Graft versus host disease(GVHD)prevention scheme: cyclosporin(Cs A)plus short treatment of methotrexate(MTX),or Cs A,MMF combined with short course MTX.RESULTS: 1.The results showed that 47 patients acquired neutrophils reconstitution,and 1 cases failed(1 case of UD group);There were 45 cases got platelet implantation and 3 cases failed(1 cases of Haplo group,1 case of UD group,1 cases of MSD group).A total of 28 patients(including 6 cases of haplo-hsct group,3 cases of ud-hsct group,and 19 cases of MSD-HSCT group)were recovered to normal by the end of the follow-up period,November 1,2017(median follow-up period: 20.2 months).The median time of Haplo-HSCT group neutrophils(ANC)implantation was 18(11-74)days,and the implantation rate was 100%.The median time of platelet(PLT)implantation was 36.5(14-109)days,and the implantation rate was 88.9%.In the UD-HSCT group,the median time of implantation was 16(13-25)days,and the implantation rate was 90%.The median time of PLT implantation was 27(16-72)days,and the implantation rate was 90%.The median time of the ANC implantation of the MSD-HSCT group was 15(9-31)days,and the implantation rate was 100%.The median time of PLT implantation was 22(11-95)days,and the implantation rate was 96.6%.2.Incidence of acute graft versus host disease(a GVHD)of three groups was 22.2%,30% and 34.5% respectively,the incidence of chronic graft versus host disease(c GVHD)was 0,10%,13.8% respectively,The a GVHD and c GVHD differences between groups have no significance(P > 0.05).The 5-year survival rates of MSD-HSCT,Haplo-HSCT and UD-HSCT were 44.4%,48.0% and 79.4% respectively.CONCLUSION:1.Neutrophils and platelet implantation rate and 5-year survival rate were the highest in MSD-HSCT group,It is prefer for SAA patients to choose sibling matched donor transplantation.2.Since Haplo-HSCT has many advantages,such as a wide range of sources,good hematopoietic reconstruction,less graft rejection and GVHD,it can be used as an alternative treatment for SAA patients without HLA matched donors.3.The efficacy of UD-HSCT is similar to that of haplo-HSCT,besides the source is limited and there are more complications,the role of UD-HSCT should be reassessed and further investigation is needed. |
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