当科における造血幹細胞移植の実績と成績

Abstract

当科では 1995 年以来 2023 年 6 月までに 228 症例に対して延べ 261 回の造血幹細胞移植を実施した．内訳は同種移植 146 回 （血縁骨髄 11 回，血縁末梢血 39 回，非血縁骨髄 32 回，非血縁末梢血 9 回，非血縁臍帯血 55 回），同系移植 1 回，自家移植 114 回であった．初回移植からの 5 年生存率は同種移植 45.1%，自家移植 73.7% であった．同種移植に於いては近年，強度減弱前処 置の開発，臍帯血移植やヒト白血球抗原半合致移植による代替ドナーの拡がりにより高齢患者やこれまでドナーが見つからな かった患者に対しても造血幹細胞移植が広く行われるようになっているが，当院でも高齢患者や代替ドナーの移植が増加傾向 にありながら一定の治療成績を維持している．移植片対宿主病の予防ならびに治療法，感染症対策，再発予防策の発展により， 今後さらなる治療成績の改善も期待したい．

Of the 261 hematopoietic stem cell transplantations performed on 226 patients between 1995 and June 2023, 146 were alloge neic transplantations (11 related bone marrow, 39 related peripheral blood, 32 unrelated bone marrow, 9 unrelated peripheral blood, and 55 unrelated cord blood), 1 syngeneic transplantation, and 114 autologous transplantations. The overall survival rate five years from first transplantation was 45.1% for allogeneic transplantation and 73.7% for autologous transplantation. In recent years, allogeneic hematopoietic stem cell transplantation has been widely performed for elderly patients and patients who could not find a human leukocyte antigen (HLA)-matched donor owing to the development of reduced-intensity conditioning regimen and the expansion of alternative donors such as cord blood transplantation and HLA-haploidentical transplantation. The favorable outcome has continued even with the increase in transplantation in elderly patients and transplantation from alternative donors. We expect further improvement of treatment outcome in the future with the further development of methods to prevent and treat graft versus host disease (GVHD),and better control of infections and prevention of recurrence.