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相關文獻
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題 名 | Bone Marrow Transplantation with HLA Partially Matched Related Donors=人類白血球抗原(HLA)部分吻合之親屬間骨髓移植 |
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作 者 | 陳博明; 邱宗傑; 謝瑞坤; 曾成槐; 王緯書; 顏厥全; 董筱玲; 劉俊煌; | 書刊名 | 中華醫學雜誌 |
卷 期 | 58:6 1996.12[民85.12] |
頁 次 | 頁385-391 |
分類號 | 415.635 |
關鍵詞 | 骨髓移植; 人類白血球抗原部分吻合之親屬; Bone marrow transplantation; HLA partially matched related donors; |
語 文 | 英文(English) |
中文摘要 | 背景 只有約四分之一的病人可以找到人類白血球抗原 (HLA) 完全 吻合的兄弟姊妹來進行骨髓移植。當病患極需接受骨髓移植而沒有HLA相吻合 的捐髓者時,就必須尋找其他的骨髓來源,其中有一種方法,就是HLA部分吻 合之親屬間骨髓移植。我們報告台北榮民總醫院進行HLA部分吻合之親屬間骨 髓移植之經驗。 方法 於西元1985年及1994年間,一共有121位病患接受親屬間骨髓移植。 其中有10位接受HLA部分吻合之親屬間骨髓移植,包括兩位急性骨髓性白血 病 (ANLL),五位慢性骨髓性白血病 (CML) 以及三位嚴重再生不良性貧血 (SAA)。白血病的病人接受移植前之調理治療為Busulfan + Cyclophosphamide (Cy) 或Cy + 全身放射治療 (TBI),嚴重再生不良性貧血的病人則接受Cy + TBI。移 植後以環孢靈 (Cyclosporin-A) 以及 methotrexate 來預防移植物對抗宿主疾病。 平均追蹤時間為三十六個月,在HLA-A,B或D三個區段 (locus) 之間,有7 例是2個區段不吻合,有3例則是3個區段都不合。 結果 平均植入 (engraftment) 的日數為20.9天,有一人發生未植入 (non- engraftment),有二人發生延遲性植入失敗 (delayed graft failure),一人出現肝靜 脈栓塞疾病 (VOD)。嚴重急性移植物對抗宿主疾病 (二至四級) 之發生率不高, 於HLA全吻合者為13.6%,於一區段不合者為31.6%,於二區段不合者為16.7% (p = 0.492),十例中有五位病人死亡,存活的五例均經過36個月的平均追蹤。經 Log-rank存活分析顯示,於HLA 2或3區段不合者與1區段不台者其存活並無 差別 (p = 0.146),然於HLA 2或3區段不台者與全吻合者其存活則有統計學上 之差異 (p = 0.0359)。 結論 當病人需要接受骨髓移植而沒有HLA吻合之親屬間捐髓者時,HLA部 分吻合之親屬間骨髓移植亦是一可行之方法,尤其當病人患有嚴重再生不良性 貧血,慢性骨髓性白血病,或是經傳統治療失效之血液惡性疾病患者。 |
英文摘要 | Background. Approximately one-fourth of patients who could benefit from bone marrow transplantation (BMT) are served by a genotypically identical sibling donor. When patients do not have an HLA-matched donor, alternative marrow sources should be explored. The way to allow survival in some patients is to perform two- or three-loci HLA mismatched BMT. Preliminary results with BMT in partially-matched, related donors performed at Veterans General Hospital- Taipei are reported. Methods. Between 1985 and 1994, a total of 121 patients were enrolled in this study. Ten patients received BMT with HLA partially-matched, related donor, including 2 acute nonlymphocytic leukemia (ANLL), 5 chronic myelocytic leukemia (CML) and 3 severe aplastic anemia (SAA). Three and four hematologically malignant patients received cyclophosphamide (Cy) + radiotherapy (RT) and Cy + Busulfan (Bu) preconditioning regimens, respectively; three SAA patients received standard Cy + RT regimen. Additional prophylaxis against graft-versus-host disease (GVHD) consisted of methotrexate (MTX) and cyclosporin-A (CSA). The median follow up was 36 months. Seven were 2-loci disparate and 3 were 3-loci. Results. Engraftment developed with a mean of 20.9 days after transplant. Nonengraftment rate was 1/10 (10%), delayed graft failure 2/10 (20%) and venoocculsive disease (VOD) 1/10 (10%). The percentage of patients who developed grade II to IV acute GVHD was low (13.6% of those mismatched at 0 locus, 31.6% mismatched at 1 loci and 14.3% at >= 2 loci. p = 0.181). Extensive chronic GVHD occurred in 16.7% (34.1% of those mismatched at 0 locus, 41.2% mismatched at 1 loci and 16.7% at 2 loci. p = 0.492 ). There were five deaths. The other 5 still survived at 36 months of follow-up. Log-rank analysis revealed no statistical significance between those mismatched at >= 2 vs at 1 (p = 0.146) but the difference between those mismatched at >= 2 and at 0 (p = 0.0359) was statistically significant. Conclusions. When patients requiring BMT without an HLA identical sibling donor, an alternative transplant from haploidentical family members remains a viable option, especially when a patient has CML, SAA or other refractory hematologic malignancies. |
本系統中英文摘要資訊取自各篇刊載內容。