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急、慢性移植物抗宿主(GVH)病,是使同种骨髓移植受体患病和死亡率更高的一个原因。急性 GVH病的特征是红斑性斑丘疹、肝细胞酶升高、腹泻,有时发生溶血小板性血小板减少。据动物实验所见,有人假定人的 GVH 病是供体淋巴细胞对受体组织相客性抗原攻击所致。根据分型资料,认为人类“组织相容性”供一受配体的 HLA 的 A、B、C 和 D 位点是相同的,所以有人提出这种攻击是直接对非 HLA 位点上的抗原。本文报告3例急性白血病患者在接受同卵孪生子骨髓移植后出现急性 GVH 病。病例1是11岁男孩,患复发性成淋巴细胞白血病,病例2是9岁女孩,患急性粒细胞白血病;病例3为35岁妇女,出现慢性粒细胞白血病的原始细胞危象。这3例均存移植前以阿糖胞苷、环磷酰胺和全身照射作准备。
Acute and chronic graft versus host disease (GVH) is a cause of morbidity and mortality of allogeneic bone marrow transplant recipients. Acute GVH disease is characterized by erythema rash, elevated hepatocyte enzymes, diarrhea, and sometimes thrombocytopenia. According to animal experiments, it was assumed that human GVH disease is caused by donor lymphocytes attacking the guest antigen of the receptor. Based on the typing data, it is considered that the human “histocompatibility” sites for HLA A, B, C, and D of the subject ligand are the same, it has been proposed that such an attack be directed to antigens on non-HLA sites . This article reports the emergence of acute GVH in 3 patients with acute leukemia after receiving identical twin twin bone marrow transplantation. Case 1 was an 11-year-old boy with recurrent lymphoblastic leukemia. Case 2 was a 9-year-old girl with acute myeloid leukemia. Case 3 was a 35-year-old woman with a blast crisis of chronic myeloid leukemia. All 3 cases were treated with cytarabine, cyclophosphamide and general radiation before transplantation.