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异基因造血干细胞移植后淋巴细胞增殖性疾病临床观察

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Keywords: 移植后淋巴细胞增值性疾病,PTLD中枢侵犯,利妥昔单抗,EB病毒,异基因造血干细胞移植

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Abstract:

目的观察异基因造血干细胞移植(allo-HSCT)后淋巴细胞增殖性疾病(PTLD)的临床特征、治疗及转归。方法9例(4例急性淋巴细胞白血病,2例淋巴瘤,2例再生障碍性贫血和1例急性髓系白血病)患者行allo-HSCT。预处理方案包括4例全身放疗(TBI)+环磷酰胺(CY)+依托泊苷(VP-16)、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+CY、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+VP-16、2例Flu+CY、1例TBI+CY。以环孢素A(CSA)、霉酚酸酯(MMF)、抗淋巴细胞球蛋白(ATG)加短程甲氨蝶呤(MTX)预防aGVHD。结果9例患者发生PTLD的中位时间为移植后60(42-510)天,8例伴前驱EB病毒感染,4例出现PTLD中枢侵犯。经美罗华外周静脉注入及鞘内注射治疗,7例患者病情得以控制,2例死亡,治疗总有效率为77.7%。结论PTLD是allo-HSCT后少见的最严重并发症之一,美罗华外周静脉注入及鞘内注射治疗PTLD合并中枢侵犯效果明显,为一线治疗方案。

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