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hematopoietic stem cell transplantation; HSCT /


hematopoietic stem cell transplantation; HSCT HSCT


1939
1965 1968


Wiskott-Aldhch

1969~75 HLA 1975~





?

GVT

?







? ?

HST
CD34+ Thy-1+ C-Kit + Lineage HLA-DR CD38 Rhodamine123dull 4-HC Resistant 5-Fu Resistant Ly6A(Sca-1)+ Thy-1 C-Kit Lineage Sca-2 +
Rhodamine123dull 5-Fu Resistant



BMT

PBSCT
UCBT FLCT







HLA


HLA
HLA HLA HLA

HLA

A B C


HLADRDQ DODNDP

HLA HLADR

BDC


1.;
2.;
3.; 4.HLA.
HLA,CMV,,,





G-CSF,GM-CSF



PBSCT

-PBSCT


-PBSCT

BMT








?

TBI
¦12~15.75Gy TBI+CYTBI+VP16TBI+CY+VP16

?

TBI
BU+CY VP16+BU +CY+ VP16 BEAM AML

NST
1
Fludara 30mg/m2.d-1 6 d

BU 4mg/kg. d-1 2 d
ATG 15mg/kg . d-1 4 d

2
TBI 200 cGy + Fludara 30mg/m2. d-1 3 d


? BMTN4

0.5109/LPLT

50109/L4
? G-CSF5g/(kg.d)

N 0.5109/L

5-8


?

nonmyeloablative hematopoietic stem cell transplantation ,NSTminitransplantation

? NSTHCT

chimerism HSC donor lymphocytes infusion ,DLI graft-versusleukemia ,GVL

? NST

GVL >50NST fludarabine



? PBSCT

PBSCTauto- PBSCTPBSCT Allo-PBSCT

?

/


?

/ PBSCT /, / PBSCT PBSCTPBSCT


?

1
/ / auto- PBSCT

?

n /

? /

PBSC§ 3-4

? 2

80 G-CSF GM-CSF MCSFIL-3IL-6IL-8SCF PBSCا , Allo-PBSCT

?

G-CSF , 5-16g/kgG-CSF, 5-6, l3 PBSC,GM-CSF G-CSFGM-CSF G-CSF

3
?

Auto-PBSCT ? ,PBSC, CHOPGCSFPBSC

Auto-PBSCT
Auto-PBSCT PBSC ? Auto-PBSCTPBSCHLA GVHD Allo- PBSCT 10
?

?

/ IBMTR Auto-PBSCT

Auto-PBSCT
? ?

?

1PBSC 2 k PBSC 3 4

?

Auto-PBSCT
?


Auto-PBSCT
?





?

/ CD34+ , ?

Allo-PBSCT
?

1989Allo-PBSCT , Allo-PBSCT Allo-BMT 1995 AlloPBSCT

1
?

PBSC10ug/kg/ CD34+G- CSF 10ug/kg/CD34+ EBMT NMDPG-CSF 10ug/kg/

?

G-CSF46CD34+ 56(peak)7 CD34+ 4612 45106/kg1106/kg


? 1G-CSF ? 2

G-CSF

? G-CSF

10 G-CSF MDS 5 3-6, G-CSF

? PBSC

ACD-A ACD ACD-A

2Allo-PBSCTGVL
? Allo-PBSCTAllo-BMT

: lCD34+ 2T10-20 3G-CSFT G-CSFT

? Allo-PBSCTT

y T GVHD Allo-BMT GVHD GVHDGVL

?

Allo-BMT PBSCTBMTPBSCT ڦPBSCT BMT Allo-PBSCTAllo-BMT

3PBSCTUPBSCT
?

70BMUBMT 500 G-CSFPBSCUPBSCT UPBSCT UBMT UPBSCT

? UBMTUPBSCT

1PBSCTCD34+ 2aGVHD UPBSCT GVHD UPBSCTGVHD GVL᧻


TRANSPLANT-RELATED COMPLCATIONS


GVHD VOD ]

CSF
? (CSF):G-CSFGM-CSFEPO

TPO
? G-CSFGM-CSF


? EPO



1CMVCMV 2GVHD


1 2


130% 21~2109/L


HBV 1/63000 HCV 1/103000HIV 1/493000

ABO
ABO(O):

ABO(O):
ABO(AB):

ABO
ABO (AB) O A ABO 0B OO B ABO B A OO ABAB


TBI

CTX











1

TPN+
1
2

2

3

GVHD






GVHD
HLA






GVHD
?

100, 100

GVHD
+ () umol/l(mg/dl) (ml)

25% 25%~50%

34~51(2~3) 51 ~103(3~6)

500~1000 1000 ~ 1500

++

+++



103 ~ 257 (6~15)

1500

++++



257

/

GVHD
() +~++ 0 0 0

()
() ()

+~+++
++~+++ ++~++++

+
++~+++ ++~++++

+
++~+++ ++~++++

+
++ +++

GVHD
MTX CSA FK506

Campath




GVHD

T T CD34+ T

GVHD
11~2mg/kg.d-1


2OKT3CD25TNF


3ATGMMF

GVHD
1CSAFK506 2 3+PUVA 4Etretinate(A

5
6MMF 2g/d

























CMV BK

(VOD)
: 1 2 3 4

1

2
31

4

VOD
91% 77%



1tPA 30%~40%
2Defibrotide 42%

VOD

3AT-




25%30%
MOSF

VOD
? 1
? 2


CML60~70% AML15.4~29% ALL0~18.2%



DLI

GVHD:42~60%



:18.6~34%











CMVIP




2%CTX CTX

CTXBK
TBI TTP


2




]











/









, ǧ









HSCT5%
CML CP AP BC CLL MDS AML CR1 CR2
55~60

ALL MM CR1CR2 50 40 40 30 30 35

/

NHL

HD

70 40 15

50

45

40 30

40 40

40

50

50




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