Blood:中国地贫造血干细胞移植治愈率可高达九成

2012-12-05 Blood Blood

李春富,男,教授,硕士导师,现为南方医科大学附属南方医院儿科主任。擅长现代造血干细胞移植治疗地中海贫血;造血干细胞移植治疗儿童白血病及恶性肿瘤;血液系统疾病、系统性红斑狼疮等自身免疫性疾病、小儿肾病等疾病的诊治。现任国际地中海贫血协会科学合作者;广东省儿科专业委员会常委;《实用医学杂志》特约审稿专家,中华儿科杂志审稿专家。     

我国地贫造血干细胞移植治愈率为90% 李春富,男,教授,硕士导师,现为南方医科大学附属南方医院儿科主任。擅长现代造血干细胞移植治疗地中海贫血;造血干细胞移植治疗儿童白血病及恶性肿瘤;血液系统疾病、系统性红斑狼疮等自身免疫性疾病、小儿肾病等疾病的诊治。现任国际地中海贫血协会科学合作者;广东省儿科专业委员会常委;《实用医学杂志》特约审稿专家,中华儿科杂志审稿专家。

       南方医科大学南方医院一篇有关治疗
地中海贫血的临床研究论文近日在国际权威血液学杂志《Blood》上发表。该研究因其约90%的地贫移植治愈率等结果引起血液学界高度关注,代表了当前国际上造血干细胞移植治疗地贫的显著进步,标志着我国在该领域的临床研究达到国际领先水平。

       这项题为《新移植方案改善了地中海贫血非亲缘供者移植的结果》的研究由亚洲儿童骨髓移植临床研究委员会主席、南方医科大学南方医院儿科主任李春富和其研究团队完成。

       该研究采用基于静脉注射白消安、环磷酰胺、氟达拉滨和塞替派的“南方-08-地贫”(NF-08-TM)新移植方案,着重对82名重型β地贫患者进行了分析。其中52人进行了异源外周血造血干细胞移植(PBSCT),其供体来自非亲属干细胞;另外30人来自亲属供体进行的造血干细胞移植。这些患者移植时的平均年龄为6岁,男女患者的比例为5626,平均随访时间为24个月。

       研究结果显示,两组患者预期的3年总生存率和无β地中海贫血生存率分别为92.3%和90.4%(非亲属组),以及90.0%和83.3%(亲属组);移植物排斥反应,以及III-IV级急性移植物抗宿主病的累计发生率分别为1.9%和9.6%(非亲属组),6.9%和3.6%(亲属组);移植相关死亡的累积发生率是7.7%(非亲属组)和10.0%(亲属组)。

       李春富介绍,2008年之前,我国造血干细胞移植治疗地中海贫血治愈率为60%左右,成功率低。本研究运用新的疾病分层方法,结合NF-08-TM地贫移植方案,治愈率高达90%以上。

       地中海贫血又称海洋性贫血,是一组因合成血红蛋白的珠蛋白肽链合成障碍而导致的遗传性溶血性贫血,其中以β和α地中海贫血较为常见。该病在全球热带和亚热带广为流行,广东全省估计仅中重度β型地贫病人就有3000人左右,且每年新增重型β地贫患儿约200人。



Abstract
We used a novel NF-08-TM transplant protocol based on intravenous busulfan, cyclophosphamide, fludarabine, and thiotepa in 82 consecutive patients with β-thalassemia major (TM), including 52 with allogeneic peripheral blood stem cell transplantation (PBSCT) from unrelated donors (UDs) with well-matched human leukocyte antigens and 30 with hematopoietic stem cell transplantation (HSCT) from matched sibling donors (MSDs). The median age at transplantation was 6.0 years (range, 0.6-15.0 years), and the ratio of male-to-female patients was 56:26. The median follow-up time was 24 months (range, 12-39 months). The estimated 3-year overall survival and TM-free survival were 92.3% and 90.4% in the UD-PBSCT group and 90.0% and 83.3% in the MSD-HSCT group. The cumulative incidences of graft rejection and grades III-IV acute graft-versus-host disease were 1.9% and 9.6%, respectively, in the UD-PBSCT group and 6.9% and 3.6%, respectively, in the MSD-HSCT group. The cumulative incidence of transplant-related mortality was 7.7% in the UD-PBSCT group and 10.0% in the MSD-HSCT group. In conclusion, UD-PBSCTs using the well-tolerated NF-08-TM protocol show similar results to MSD-HSCTs and can be used to treat β-thalassemia patients in the absence of MSDs.

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    2013-04-21 cenghis
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    2012-12-06 俅侠

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