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血液疾病患者的福音 親子間半吻合周邊血造血幹細胞移植移植

【記者 玉女 台中 報導】

急性白血病(血癌)、惡性淋巴瘤、再生不良性貧血、及骨髓分化不良等困難治療的血液疾病,若病人有機會接受異體周邊血造血幹細胞移植,是有可能痊癒的。但傳統上只有三分之一的病患可以找到HLA (人類白血球抗原) 配型完全相合的周邊血造血幹細植捐贈者。剩下的三分之二病患就因為沒有合適的周邊血造血幹細胞捐贈者而無法受益於周邊血造血幹細胞移植。其他替代的造血幹細胞來源包括臍帶血幹細胞、HLA配型不相合周邊血造血幹細胞及HLA配型半吻合 (親子間) 造血幹細胞幹細胞。臍帶血幹細胞因為細胞數目不足並不足夠成人患者使用,而HLA配型不相合周邊血造血幹細胞移植則因排斥情形較嚴重,且因當代幹細胞來源越來越多樣化而式微。於是HLA配型半吻合周邊血造血幹細胞因取得的便利性,漸漸成為親屬間配型全合周邊血造血幹細胞移植外最常用的替代方案。

親子間半吻合造血幹細胞移植最早於90年代由美國約翰霍普金斯大學發展,後因中國一胎化政策的時空背景,病患普遍無配型全合的捐贈者,親子間半吻合造血幹細胞移植移植得以大量施行並確立臨床療效。全世界各大醫院亦紛紛跟進施行此種治療方式。

臺中榮總自104年3月底開始第一例親子間半吻合周邊血造血幹細胞移植,案例數逐年成長,在最近四年時間,每年將近有10位血液病患者接受親子間半吻合異體周邊血造血幹細胞移植。截至107年3月底統計結果來看,在接受半吻合異體周邊血造血幹細胞移植的17位急性白血病患者中,平均年齡為51歲,年齡最大為74歲,最年輕為25歲,男性病患佔43%,中位數追蹤時間為10.5個月(追蹤最久的已36個月),移植後一百日存活率為100%,長期存活率為76.2%。急性排斥的發生率為62%,慢性排斥的發生率為9.5%。以上治療成績皆與傳統的配型全合之親屬或非親屬周邊血造血幹細胞移植的治療成績相當。值得一提的是,半吻合異體移植會有較高的移植後巨細胞病毒感染的併發症,因此需要在移植前後例行性使用抗巨細胞病毒藥物治療,本研究成果已經被期刊 “移植與傳染病雜誌” 所接受。

本院案例中,有幾個案例是令人印象深刻的。一位36歲的女性,先前罹患低風險的急性骨髓性白血病,經化學治療療程完成後,不滿一年就疾病復發。再度接受化學治療療程,但卻苦無配型全合的骨髓捐贈者,父母親年紀過大且子女年紀過小都不適合捐贈骨髓,最後採取親妹妹的半吻合骨髓捐贈,目前已追蹤滿兩年無復發情況下,也不需再使用抗排斥藥,重拾健康的生活。

一位29歲男性,本身為餐廳大廚,診斷急性骨髓性白血病經化學治療療程後,亦無配型全合的骨髓捐贈者,於是接受母親捐贈的半吻合骨髓移植。然而在移植成功後的一個月即因巨細胞病毒感染造成幹細胞衰竭,於是兩個月後再次進行母親的半吻合骨髓移植,並持續使用抗病毒藥治療,終於成功。目前已追蹤近兩年且無復發。母親賦與他兩次新生命的過程更令人為之動容。

另一位51歲男性,本身為公務人員,罹患中度復發風險之急性骨髓性白血病,經化學治療療程完成後,也沒有配型全合的骨髓捐贈者,遂進行兒子捐贈的半吻合骨髓移植,目前已追蹤兩年半無復發,也不需再使用抗排斥藥,重新回到工作崗位服務民眾。

還有一位44歲女性,診斷有骨髓分化不良症候群,經標靶藥物治療無效,且疾病惡化為急性骨髓性白血病,經化學治療療程完成後,也沒有配型全合的骨髓捐贈者,遂進行女兒捐贈的半吻合骨髓移植,目前追蹤亦即將滿兩年,無復發跡象,也不需再使用抗排斥藥,每三個月回門診追蹤一次。

半吻合周邊血造血幹細胞移植,是無配型全合捐贈者之血液疾病患者的一個福音。半吻合周邊血造血幹細胞移植近年來己取得能和傳統配型全合移植相同的治療成效。因為周邊血造血幹細胞移植移植的治療較複雜,所以必須由有經驗的移植中心提供評估以及醫療服務,移植後還需面對可能之感染、排斥等問題。故是否適合接受骨髓移植,除了考量病患年齡、身心靈社會層面外,仍須血液專科醫師與病患充份溝通後決定。

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