CSA,MTX,MMF??ATG??????????????????GVHD?????

1
CSA,MTX,MMF??ATG??????????????????GVHD?????

• ????????????? ???
• 2010.5.23

2
??

• ?????????????,????????????????,???????????????????
  ?????????????????????????????????????,????????????
  ??(GVHD)????????

3
??

• ??????GVHD???,????????????????????????????????
• ????????2002?4??2007?6????33????????????????????

4
?????
5
??

• ?20?,?13??????30(13-50)??
• ALL CR1 6?
• AML CR1 7?,CR2 2?,CR3 1?,NR 5?
• ????????(AUL) CR1 1?
• CML CP 7?,AP 2?
• MDS 1?
• SAA 1?

6
???????????

• ????
• ???????????????????(CP)???????????(CR1
  ?CR2)????????????27??
• ????
• ???????????AP????BP??????CR3????????6??

7
HLA???????

• HLA?????(HLA-A,-B,-CW,-DRB1,-DQ??)
• ????21?
• 1?A????6?
• 1?B????4?
• 1?DR????2?
• ???ABO????11?
• ????????????????????

8
?????

• ???Bu/Cy??26?
• ???(Bu) 1mg/(kg6h)3d ????(Cy)
  60mg/(kgd)2d ????(Arac) 3.0g/m2
  ???????(MeCCNU) 250mg/m2?????(VM-26) 300mg/m2?
• ????(TBI) ????(Cy)??????6?
• ????4.5 Gy2d ????60mg/(kgd)2d
  ????(Arac) 3.0g/m2?
• FluBUATG?? 1?
• Flu 50mg/d5d???(Bu) 1mg/(kg6h)3d??????????
  ???

9
??????????

• ????CsAMTXMMFATG
• CsA 2-3mg/kg/d,?-3???,????200-400ng/mlMTX
  ?1??15mg/m2,???3?6?11????10mgMMF 1.0g/d 30
  d (?-1?????) ?28???)?ATG??????????(-4??-1?),2.5mg
  /(kgd)4d (???,????)?5mg/(kgd)4d (??????)?
• ???13?????CD25??(??, Novartis)20 mg,
  1??2?,1??0???, 2 ???????0 ??4 ????

10
????

• ????
• G-CSF
• ?????
• ?????
• ??????

11
??????

• ??????0.5109/L
• ????
• ??????
• DNA???????PCR??(GeneScan)

12
? ?
13
?????????

• ?????gt 0.5?109/L13(10-22)?
• PLTgt20?109/L17(9-71)?
• 33?????????????, STR-PCR GeneScan?????28??????????
  100????

14
GVHD????????
15
????GVHD??????
5-year OS between different groups ?URD-ATG,
?URD-ATGCD25,plt0.05.
16
?????????????
3-year OS between different groups remission
and progression,plt0.05.
17
? ?
18

• ????
• 33????100??,??????,??????????HLA?????????,???????
  ????????????????????????
• 33?????12??HLA??1???????,?????????????,HLA??1?????
  ?????????,?????????

19

• GVHD???
• ?????URD-HSCT?,??GVHD??????47-79??GVHD ????(CSA
  MTX) ?URD-HSCT ???GVHD ?????60???
• ?????,URD-PBSCT?,aGVHD???????36.36 (12/33)
  ,???12??HLA??1???????,??CD25???aGVHD????????23.07
  ????CD25???aGVHD???(45)??????????????????????

20

• ???????
• URD-ATGCD25?????(53.84)????URD-ATG?(15)?
• ?????URD-ATG?????????????????????(Plt0.01) ?

21
Thank you