【摘要】 目的 探讨自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）治疗侵袭性NK/T细胞淋巴瘤的疗效。 方法 对我科2005年1月16日收治的1例侵袭性NK/T细胞淋巴瘤患者的造血干细胞移植和随访资料进行回顾性分析，并复习国内外相关文献。 结果 患者为37岁女性，诊断结外鼻型NK/T细胞淋巴瘤，系统性，经CHOAP和ICE方案化学疗法、手术、局部放射治疗控制病情良好后，采集自体骨髓造血干细胞，行auto-HSCT，预处理方案为全身放射治疗+ECy；移植+29 d造血功能即顺利重建；移植后密切随访，患者一直处于完全缓解，至今已存活67个月。 结论 auto-HSCT治疗侵袭性NK/T细胞淋巴瘤疗效肯定、可靠。【Abstract】 Objective To explore the therapeutic effect of autologous hematopoietic stem cell transplantation (auto-HSCT) on aggressive NK/T lymphoma. Methods The clinical data of one patient with aggressive NK/T lymphoma diagnosed in January 2005 were retrospectively analyzed, and the relevant domestic literatures were analyzed. Results This thirty-seven-year-old female patient had good disease control after undergoing chemotherapy with CHOAP and ICE regimens, surgery, and locoregional radiotherapy. After that, she had been collected enough bone marrow-derived hematopoietic stem cells, then underwent auto-HSCT with these cells. The conditioning regimen was TBI plus ECy. On the +29th day after transplantation,the hematopoietic reconstruction was successful. During the follow-up period, the patient was in complete remission status all along and her disease-free survival (DFS) was 67 months. Conclusion Auto-HSCT is effective on aggressive NK/T lymphoma.
【摘要】 目的 分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并发毛细血管渗漏综合征（capillary leak syndrome，CLS）的发生率、危险因素和结局，并探讨其防治措施。 方法 回顾性分析2005年6月-2011年2月住院的allo-HSCT术后14例并发CLS的临床资料。 结果 CLS发生率为9.2%（14/152）。年龄、性别、诊断、HLA配型、预处理、CD34+细胞量、粒细胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入时间均不能认定为造血干细胞移植后CLS诱发因素。 结论 HSCT术后CLS诱因尚不清楚，采用限水、减量G-CSF、使用糖皮质激素和羟乙基淀粉等措施及时治疗，有助于控制CLS。【Abstract】 Objective To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment. Methods We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011. Results Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS. Conclusions Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.
【摘要】 目的 分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相关的危险因素，动态监测受者尿BK病毒（BK virus，BKV），分析其与HC发病的关系。 方法 回顾性分析2003年3月-2008年1月期间接受allo-HSCT的121例患者的资料，选择8个临床参数[年龄、性别、疾病类型、移植时疾病状态、供者类型、预处理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的预防方案]作COX回归分析。采用SYBR Green染料实时荧光定量聚合酶链反应法对2006年9月-2008年1月42例allo-HSCT患者尿BKV载量进行动态监测，分析被检查者尿液BKV基因载量与HC发生以及严重程度的关系。 结果 121例患者中有24例发生HC，发病时间为术后0~63 d，中位时间40 d；持续时间7~150 d，中位时间22 d。Ⅱ~Ⅳ度aGVHD为HC的独立危险因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV检出率为100%（42/42）。与正常人及未发生HC的allo-HSCT受者相比，HC患者尿中BKV基因载量具有更高平均峰值。 结论 Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高载量与HC的发生有相关性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
【摘要】 目的 探讨对自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗的临床疗效。 方法 收集2000年1月-2010年12月难治性恶性淋巴瘤采用auto-HSCT后复发患者11例，病程27个月~6.5年。所有患者在auto-HSCT前均为复发难治性病例，auto-HSCT后，完全缓解8例，部分缓解3例，自体移植后中位复发时间15个月，患者复发后采用异基因亲缘造血干细胞移植，人类白细胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性别相同6例，性别不同5例。预处理方案为FBC方案，即氟达拉滨30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，环磷酰胺120 mg/kg分2 d使用。移植物均为外周血造血干细胞加骨髓。移植物抗宿主病（graft-versus-host disease，GVHD）的预防：HLA全相合采用环孢素+短程甲氨蝶呤+吗替麦考酚酯，不全相合采用抗胸腺细胞球蛋白+环孢素+短程甲氨蝶呤+吗替麦考酚酯。 结果 11例患者全部获得造血重建，急性GVHD发生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；发生慢性GVHD 7例（63.64%），其中有2例急性GVHD转为慢性，4例局限型，3例广泛型。随访8个月~9年，有4例分别于移植后8、15、21、34个月疾病复发，另外6例仍生存。 结论 allo-HSCT对于auto-HSCT后复发的非霍奇金淋巴瘤患者仍是一种有效的挽救性治疗手段。【Abstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
【摘要】 目的 了解人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病的临床疗效。 方法 对2002年1月-2010年12月因造血干细胞移植并发重症肝静脉闭塞病的6例患者，利用人工肝支持系统，选用血浆置换程序进行血浆置换。 结果 6例患者经血浆置换治疗后，胆红素均明显下降，3例最终恢复，2例因肝功能再次恶化死亡，1例死于严重混合性感染。 结论 人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病是一种新的尝试，是有效和可靠的。【Abstract】 Objective To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation. Methods Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system. Results After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections. Conclusion Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.
目的 调查造血干细胞移植出院患者的社会支持现状，寻求相应的护理对策，帮助患者保持较高的社会支持水平。 方法 选择2007年9月-2009年3月在层流病房进行造血干细胞移植的患者48例，采用肖水源的社会支持评定量表，进行住院期间和出院3个月后的问卷调查，并进行统计学分析。 结果 患者住院期间社会支持总分为(41.40±5.60)分，出院3个月后社会支持总分为(38.19±3.65)分，比较具有统计学意义(Plt;0.05)。 结论 造血干细胞移植患者出院后社会支持水平降低，护士应加强对造血干细胞移植患者出院后的指导，拓宽造血干细胞移植出院患者社会支持渠道，帮助患者保持较高的社会支持水平，从而促进患者的康复。