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Effects of Improved Non-Myeloablative Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

Author: Yu
Tutor: GeLinFu
School: Taishan Medical College
Course: Geriatrics
Keywords: Aplastic anemia Nonmyeloablative Hematopoietic stem cell transplantation T lymphocyte subsets Fas Cytokines
CLC: R556.5
Type: Master's thesis
Year: 2007
Downloads: 18
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Abstract

Objective: To observe the research and improvements nonmyeloablative hematopoietic stem cell transplantation in the treatment of severe aplastic anemia patients blood, bone marrow, bone marrow hematopoietic progenitor cells in vitro cultivation recovery of clinical efficiency, long-term survival and mortality of modified non- myeloablative hematopoietic stem cell transplantation in the treatment of severe aplastic anemia feasibility and superiority, adapt to levy and adverse reactions, severe aplastic anemia, to provide a safe and effective treatment options for clinical treatment. 2, observed severe aplastic anemia patients in improved nonmyeloablative hematopoietic stem cell transplantation therapy before, after \2) the level of changes, and discuss its clinical significance nonmyeloablative hematopoietic stem cell transplantation in the treatment of acute severe aplastic anemia feasibility and efficacy to further determine the improvement of clinical applications, monitoring the degree of progression of the disease in patients with prognostic provide objective theoretical basis. MATERIALS AND METHODS: collection of Jinan Military Region General Hospital Department of Hematology improved nonmyeloablative hematopoietic stem cell transplantation in the treatment of 30 cases of severe aplastic anemia patients hospitalized in August 2001 to November 2005. ① research and fully matched donor matching patients with severe aplastic anemia after transplantation, hematopoietic recovery, complications, and clinical efficacy in patients with anemia, 60 cases of heavy medication regeneration obstacles as the control group. Not exactly match the patients with severe aplastic anemia ② Research and donor, with type of hematopoietic recovery, complications, clinical efficacy. (3) research for non-kinship with severe aplastic anemia treated with cord blood transplantation after hematopoietic recovery, complications, and clinical efficacy. ④ Compare severe aplastic anemia patients with type I and heavy regeneration anemia in patients with type Ⅱ hematopoietic recovery after transplantation, complications and clinical efficacy. And its statistics, sum, sum. 2, collected the Jinan Military General Hospital, Department of Hematology, hospitalized 30 cases improved nonmyeloablative hematopoietic stem cell transplantation in the treatment of heavy regenerative anemia patients before transplantation, three months after the transplant, six months, from August 2001 to November 2005 peripheral blood, bone marrow samples, 16 cases of healthy volunteers as a control group. Peripheral blood T lymphocyte subsets and bone marrow CD34 cell expression of Fas antigen fluorescent markers were detected by direct immunofluorescence flow cytometry using double sandwich enzyme-linked immunosorbent assay detection level of plasma sFas and hematopoietic negative regulatory factor (IFN- r, IL-2) levels. Results: 1,30 using SAA patients improved non-cleared myeloid hematopoietic stem cell transplantation in the treatment of 24 patients (80%) to meet the basic cure, and the long-term survival. 10 cases of donor blood relatives and human leukocyte antigen completely coincide with severe aplastic anemia patients, hematopoietic recovery faster than medication, less serious complications, long-term survival rate. 2,2 cases for those related by blood and human leukocyte antigen incomplete consistency (5/6), severe aplastic anemia patients, the use of improved nonmyeloablative hematopoietic stem cell transplantation in the treatment of the same make ideal clinical efficacy, blood, bone marrow and hematopoietic progenitor cells and rapid recovery, patients achieved basic cure, has long-term, disease-free survival 2 years. 3, non-Qing the medullary cord blood stem cell transplantation for unrelated improved compared with peripheral blood stem cell transplantation the hematopoietic reconstitution slightly slow, but also be able to obtain more rapid hematopoietic reconstitution, less serious complications, transplant lower risk, long-term survival rate . 4, severe aplastic anemia Ⅰ patients heavier type regenerative anemia in patients with type Ⅱ hematopoietic faster recovery, fewer complications and light, good prognosis and survival rate. Severe aplastic anemia in patients with type Ⅱ, especially the poor generally had multiple transfusions, to produce platelet antibodies in patients transplanted ineffective. 5, heavy-duty regeneration barriers of anemia in patients with bone marrow of CD34 of Fas cell expression significantly with higher than normal controls (P lt; 0.05) and severe aplastic sexual anemia in patients with type Ⅰ heavier regeneration barriers anemia Ⅱ type significantly increased (P lt; 0.05) . The plasma sFas in patients with severe aplastic anemia was significantly lower than normal (P lt; 0.05), and severe aplastic anemia patients with type I heavier regenerative anemia type Ⅱ was significantly lower (P lt; 0.05). Bone marrow CD34 Fas cell percentage gradually decreases as the duration of the extension, and a negative correlation with the course; plasma sFas level gradually increased with the duration of the extension, was positively correlated with the course. 6, the majority of patients with severe aplastic anemia presence of T lymphocyte subsets abnormal and IFN-r, IL-2 was significantly higher than that in normal controls (P lt; 0.05), and severe aplastic anemia patients with type I heavy aplastic anemia type Ⅱ significantly (P lt; 0.05). Before treatment, the presence of abnormal T-cell subsets and IL-2, IFN-r higher in patients than before treatment, there is no abnormal T-cell subsets and IL-2, IFN-r increased clinical efficient. 7, improved non-clearing effect of myeloid hematopoietic stem cell transplantation in the treatment of patients with immune abnormalities indicators after treatment can be corrected, severe aplastic anemia type II patients with severe aplastic anemia in patients with type I slow recovery. Conclusion: 1, improved nonmyeloablative peripheral blood hematopoietic stem cell transplantation in the treatment of blood ties, human leukocyte antigen matched and not completely coincide with severe aplastic anemia patients efficacy, is the treatment of choice for patients with severe aplastic anemia. 2, umbilical cord blood stem cell transplantation in patients with severe aplastic anemia not find a suitable matching timely treatment of choice. This method is particularly suitable for children, lighter-weight adults, but also according to the situation. Hematopoietic stem cell transplantation for severe aplastic anemia patients with type II treatment of choice, but when the treatment effect of multi-drug norms are poor or such disease progression in patients with cardiopulmonary liver and kidney function, and blood product transfusion fewer human leukocyte antigen matching fully matched donor hematopoietic stem cell transplantation may be considered. 4, Fas / FasL system in the pathogenesis of SAA patients passing the apoptosis signals involved in T cell-mediated cytotoxicity process play an important role in the bone marrow of patients with CD34 Fas cell percentage and plasma sFas level with the duration. 5, the most severe aplastic anemia in patients with cellular immune abnormalities characterized by T lymphocyte subsets disorders and a variety of hematopoietic negative regulator of abnormally high levels, severe aplastic anemia the type Ⅰ heavier type regenerative anemia type Ⅱ . Further prompted SAA patients with abnormally high levels in vivo immune effector cells and activation of direct or indirect damage of bone marrow hematopoietic cells is an important mechanism SAA occurred while T cell subsets in patients with preoperative IL-2, IFN-r level as reference index to predict the prognosis. Improved NSCT can correct abnormal immune Fas / FasL system in the pathogenesis of SAA, especially severe aplastic anemia type I, heavier aplastic anemia type Ⅱ quick recovery, efficient clinical.

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CLC: > Medicine, health > Internal Medicine > Blood and lymphatic system diseases > Blood diseases > Anemia > Aplastic anemia and bone marrow sclerosis,anemia
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