中文摘要：

目的对比研究强化清髓不含抗人胸腺球蛋白（ATG）方案与清髓方案单份非血缘脐带血移植（sUCBT）治疗恶性血液病的临床疗效和耐受性。方法回顾性分析2000年4月至2013年12月在安徽医科大学附属省立医院血液科接受sUCBT的190例恶性血液病患者的临床资料。移植预处理采用强化清髓不含ATG方案者（强化清髓组）共156例，其中采用全身照射（TBI）/阿糖胞苷（Ara－C）/环磷酰胺（CY）方案79例，氟达拉滨（Flu）/白消安（Bu）/CY方案47例，Ara－C/Bu/CY方案30例；全部采用环孢素A（CsA）/霉酚酸酯（MMF）方案预防移植物抗宿主病（GVHD）。移植预处理采用清髓方案者（清髓组）34例，其中采用Bu/CY方案30例，采用TBI/CY方案4例；预防GVHD方案均采用CsA/MMF±ATG±甲氨蝶呤（MTX）。对比分析两组移植时疾病状态、移植物特征、移植疗效和移植并发症。结果强化清髓组与清髓组在性别、移植时疾病类型、供受者人类白细胞抗原相合程度、供受者ABO血型相合程度、移植时疾病状态上差异均无统计学意义（均P〉0.05）；强化清髓组患者移植时中位年龄、中位体重均明显高于清髓组（13比9岁，P＝0.003；44比26 kg，P＝0.000）；强化清髓组回输的有核细胞中位数（×107/kg受者体重）及CD34＋细胞中位数（×105/kg受者体重）均明显低于清髓组（3.87比4.99，P＝0.002；2.00比3.17，P＝0.000）。植入情况：移植后42 d髓系累积植入率及120 d血小板累积植入率，强化清髓组均显著高于清髓组[96.33%（95%CI：96.27%～96.39%）比82.30%（95%CI：80.67%～83.93%），P＝0.000；86.44%（95%CI：86.28%～86.60%）比51.17%（95%CI：49.02%～53.32%），P＝0.002]。两组Ⅱ～Ⅳ度、Ⅲ～Ⅳ度急性GVHD及2年慢性GVHD发生率差异均无统计学意义（P＝0.482、0.928、0.579）。植入前综合征发生率，强化清髓组显著高于清髓组（82.70%比47.06%，P＝0.00

英文摘要：

Objective To campare the effect and tolerance beween intensified myeloablative conditioning regime （IMCR） without antithymoeyte globulin （ATG） and myeloablative conditioning regime （MCR） for single-unit unrelated umbilical cord blood transplantation （sUCBT） in hematological malignancies. Methods The clinical data of 190 patients with hematological malignancies undergoing sUCBT between April 2000 and December 2013 at Department of Hematology, Anhui Provincial Hospital were retrospectively analyzed, of whom 156 received IMCR without ATG （ IMCR group ） , including 79 patient receiving total body irradiation （TBI）/cytosine arabinoside （Ara-C）/cyclophosphamide （CY） regime, 47 receiving fludarabine （ Flu ）/busulfan （ Bu ）/CY regime, and 30 receiving Ara-C/Bu/CY regime, and all of the 156 received a combination of cyclosporine A （CsA） and mycophelonate mofetil （MMF） for the prophylaxis of graft-versus-host disease （GVHD） ; the remaining 34 patients received MCR （MCR group） , 30 patients receiving Bu/CY regime, and 4 receiving TBI/CY regime, all using CsA/MMF ：i： ATG or methotrexate （MTX） for the prophylaxis of GVHD. The two groups were compared in disease status at the time of transplantation, characteristics of graft, transplantation effect, and transplantation-related complications. Results There were no statistically significant differences between the two groups in gender, disease type, human leukocyte antigen match, ABO blood type match, and disease status at the time of transplantation （ all P 〉 0. 05）. The median age and body weight at transplantation in the IMCR group were significantly higher than those in the MCR group （ 13 years vs 9 years, P = 0. 003 ; 44 kg vs 26 kg, P = 0. 000 ）. The median doses of infused total nucleated cells （ × 107/kg） and CD34 ＋ cells （× 105/kg） in the IMCR group were significantly lower than in the MCR group （3.87 vs 4. 99, P =0. 002; 2. 00 vs 3.17, P = 0. 000）. The cumulative incidence of myel