非清髓异基因外周血造血干细胞移植后嵌合体分析_医学论文.docVIP

非清髓异基因外周血造血干细胞移植后嵌合体分析_医学论文 非清髓异基因外周血造血干细胞移植后嵌合体分析_医学论文 作者：陈宝安，熊辉霞，丁家华，苏恩本，赵刚，王骏，高冲，孙耘玉，程坚 【摘要】 本研究旨在探讨非清髓异基因外周血造血干细胞移植(NAPBSCT)后造血嵌合体的临床意义。采用FBC(氟达拉宾+白消安+环磷酰胺)±阿糖胞苷（Ara-C）预处理方案，对28例血液病患者进行NAPBSCT，采集供者和受者术前外周血及术后不同时间段的序列血样，用STR-PCR结合聚丙烯酰胺凝胶电泳、银染色和凝胶成像分析技术半定量方法计算供体细胞嵌合率。 结果显示：移植后1月，28例患者中1例移植失败，22例形成完全供者造血嵌合体(CC)，5例形成混合造血嵌合体(MC)；移植后7天时供者细胞即占优势（74.71%），较中性粒细胞（ANC）和血小板（Plt）的平均恢复时间均明显提前；CC组的aGVHD发生率高于MC组（P＜0.05），两组cGVHD发生率无显著差异（P＞0.05）；1例MC患者发生早期移植排斥；CC组和MC组复发率无显著差异（P＞0.05），1例在CC状态下复发。3例MC患者经早期临床干预治疗获得CC和完全缓解。结论：造血嵌合体的动态定量检测对判断早期植入，预测移植物排斥、复发和GVHD，以及指导临床干预治疗具有重要意义。 【关键词】 非清髓造血干细胞移植 　　Analysis of Hematopoietic Chimerism after Non-myeloablative Allogeneic Peripheral Blood Stem Cell Tansplantation 　　Abstract The aim of this study was to analyze the hematopoietic chimerism after non-myeloablative allogeneic peripheral blood stem cell transplantation(NAPBSCT).28 patients received NAPBSCT were evaluated.The conditioning regimen included FBC (fludarabine，busulphan，cyclophosphamide) ±Ara-C.Peripheral blood was collected before and after transplantation in different periods.Semi-quantitative assessment of hematopoietic chimerism was performed by short tandem repeat-polymerase chain reaction(STR-PCR)，polyacrylamide gel electrophoresis (PAGE)and silver staining，and analyzed by Image Analysis System.The results showed that on day 30 after transplantation，one patient failed to engraft，but 22 cases formed complete chimerism(CC) and 5 cases were of mixed chimerism.On day 7 after transplantation，the average percentage of donor cells was 74.71%. The time of dominance of the donor-specific allelic pattern preceded the recovery time of neutrophils and platelets.The incidence of aGVHD in group CC was significantly higher than that in group MC(P＜0.05).There was no significant difference in the incidence of cGVHD and disease relapse between group CC and group MC（P＞0.05）.One patient relapsed in CC status without a transitional stage of MC.One patient with MC rejected grafts in early stage.3