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(hematopoieticstemcelltransplantation HSCT) (hematopoieticcell,HC) HC (hematopoieticstemcellHSC)(progenitor)HSC HC CD34 40 HSCT 30 1990 EDThomas HC gHSCT HSCT HSCT HSCT (graft-versus-hostdiseaseGVHD) 1% HSC (bonemarrowtransplantation BMT) (peripheralbloodstemcelltransplantation PBSCT) (cordbloodtransplantationCBT) (relatedtransplantation)(unrelateddonortransplantation UDT)(humanleukocyteantigenHLA) HLA (haploidentical) (HLA) HIA 6 (6p21)HLA- HLA- BMT HLA-AB C DRDQDODN DP A DR B HLA DNA HLA 25% HLA 4 A*0101 A*0102 A1 HLA ˦ DNA ӵ ; HLA HLA GVHD (hostversusgraftreactionHVGR) Auto- AllcrHSCT HLA (identicalsiblings) HLA (matchedunrelateddonor MUD) HLA (cytomegalovirusCMV) HLA HLA

HLA HSCT 1996 8 PBSCT 2006 8 22 PBSCT500 29 60 ى^ G-CSF (24)108/kg (MNC) 14 2530Gy, ( AO) BMT-80 HC G-CSF (mobilization) CD34+HC Allo-PBSCT G-CSF 5 g/(kgd) 12 4 5 2 2 G-CSF5 g/kgAuto-PBSCT JCTXVP16 ] N 7 CD34+ 2106/kg MNC 5108/kgMNC CD34+ CD34- HC CBT GVHD CBT ; (total-bodyirradiationTBI) (nonmyeloablativehematopoieticstemcelltransplantation

NST)(RIC) HSCT NST HC T (chimerism) ħ HSC (donorlymphocytesinfusionDLI) (graft-versus-leukemiaGVL) NST GVL >50 NST (fludarabine) TBI 12Gy CTX60mg/(kgd) 2 VP-1660mg/kg; 1mg/(kg6h) 4 +CTX50mmg/(kgd) 4 60mg/(kgd) 2 ;ҡ§ >917ng/ml CML ; CBV [CTX+ (BCNU)+VP-16];BEAM BCNU+VP-16+Ara-C+ GVL BMT 4 0.5109/L 50109/L 4 G-CSF5 g/(kgd) 0.5109L 58 PBSCT 810 1012 CBT 562 CBT 81% 42 85% 180 10% CBT BMT PBSCT HLA 97%99%GVHD HLA (FISH ) (STR)(SNP) PCR HSCT 0.30 Hb70g/L ԧ20109/L( 10109/L) GVHD 2530Gy GVHD HVGR CMV EBV HTLV- 57 л ;712 CTX (mesna) ; 56 1

; ;; 100 ; (1) (2) 5mg/kg 8 1 Χ 1600mg/d 30 ( 40%60%) 1 CMV 35100 CMV CMV CMV CMV CMV (interstitialpneumoniaIP)CMV CMV CMV CMV R (ganciclovir GCV) (intravenousimmuneglobulin IVIG) 21 :GCV5mg/kg 12 1 IVIG500mg/kg 1 ; GCV5mg/(kgd) 5 IVIG500mg/(kgw) GCV G-CSF GM-CSF GCV CMV GCV GCV 21 CMV 1 (foscarnet)90mg/kg 500ml 2 2 7 1 CMV CMV CMV GCV5mg/(kgd) 12 1 7 GKZV5mg/(kgd) 5 100 (3) 200400mg/d B (voriconazole) (caspofunginacetate) (4) SMZco 4 2 û 2(veno-occlusivediseaseoftheliverVOD) 10% 16 1 HBV HCV HC VODVOD VOD 25%30% VOD ɧ 100U/(kgd) 30 E2 VOD 3 (GVHD)GVHD HSCT T 1966 Billingham GVHD

;; HLA 30% GVHD GVHD HLA GVHD GVHD(acuteGVHDaGVHD) 100 100 GVHD(chronicGVHDcGVHD) aGVHD 24 ܦALTASTALP GGT aGVHD ( 6-20-1 6-20-2) GVHD aGVHD T (CsA) (MTX)CsA 6 MTX15mg/m2 1 10mg/m 2 36 11 4 CsA 24mg/(kgd) 150250ng/ml{ 177 mol/L(2mg/dl) 40 CsA 5%CsA IL-2 IL-2 T CsA tacrolimusFK-506 (mycophenolatemofelil MMF)(ATG) T GVHD T CD34+ aGVHD 12mg/(kgd) ATG T IL-2 ]]MMFCsA FK-506 6 20%50% cGVHDcGVHD HLA PBSCT aGVHD cGVHD CsA MMF cGVHD TBI CsA ; CNSL ; ; MDS 3 IL-2 DLI CML (SAA) 8

(DFS) 90%<40 HLA HSCTHLA HSCT DFS 72%ڦ DFS 70%80% HSCT Fanconi ; HSCT 5 (%) 6-20-3 CM LMDSCLL ;AMLALL ] HSCT HSCT ] 10%15% cGVHD HLA n HSCT 1.Hematology2006AmericanSocietyofHematologyEducationProgramBook 2 2001 3.LichtmanM,BeutlerE,KaushanskyK,etal.WilliamsHematology.7thed.Ne wYork:McGraw-HillComl:)any,2005 4 3 2004 5.JaffeES,HarrisNL,SteinH,etal.WorldHealthOrganizationClassificationo fTumoursPathologyandGeneticsofTumoursofHaematopoieticandLymphoidTissu es.Lyon:IARCPress,2001


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