Luận án Nghiên cứu điều trị bệnh Lơxêmi bằng ghép tế bào gốc từ ngân hàng máu dây rốn cộng đồng tại Viện Huyết học-Truyền máu Trung ương

Tên luận án:

NGHIÊN CỨU ĐIỀU TRỊ BỆNH LƠXÊMI BẰNG GHÉP TẾ BÀO GỐC TỪ NGÂN HÀNG MÁU DÂY RỐN CỘNG ĐỒNG TẠI VIỆN HUYẾT HỌC-TRUYỀN MÁU TRUNG ƯƠNG

Ngành:

Huyết học và Truyền máu

Tóm tắt nội dung tài liệu:

Luận án "Nghiên cứu điều trị bệnh lơxêmi bằng ghép tế bào gốc từ Ngân hàng máu dây rốn cộng đồng tại Viện Huyết học-Truyền máu Trung ương" tập trung vào việc đánh giá hiệu quả và các yếu tố liên quan đến ghép tế bào gốc tạo máu từ máu dây rốn cộng đồng trong điều trị bệnh lơxêmi cấp. Bệnh lơxêmi (LXM) là một nhóm bệnh lý huyết học ác tính với nguy cơ tử vong cao, và ghép tế bào gốc tạo máu đồng loài được xem là phương pháp chữa trị duy nhất. Máu dây rốn nổi bật với các ưu điểm như thu thập an toàn, sẵn có, yêu cầu hòa hợp kháng nguyên bạch cầu (HLA) thấp hơn và ít biến chứng bệnh ghép chống chủ hơn so với các nguồn tế bào gốc từ người hiến trưởng thành. Tuy nhiên, tại Việt Nam, việc ứng dụng máu dây rốn cộng đồng trong điều trị lơxêmi còn thiếu các nghiên cứu chuyên sâu, toàn diện.

Nghiên cứu này được thực hiện tại Viện Huyết học – Truyền máu Trung ương từ năm 2015-2020 trên 20 bệnh nhân lơxêmi cấp. Mục tiêu chính là đánh giá kết quả sớm của phương pháp này và xác định các yếu tố ảnh hưởng đến kết quả ghép.

Kết quả nghiên cứu cho thấy ghép tế bào gốc tạo máu từ máu dây rốn là một phương pháp phù hợp và hiệu quả cho các bệnh nhân lơxêmi cấp không có nguồn tế bào gốc hòa hợp hoàn toàn từ người hiến cùng huyết thống. Phương pháp này mang lại tỷ lệ tái phát thấp và ít biến chứng bệnh ghép chống chủ mức độ nặng. Các biến chứng phổ biến thường liên quan đến tổn thương do điều kiện hóa và nhiễm trùng.

Nghiên cứu cũng chỉ ra rằng sự có mặt của các đột biến di truyền đặc hiệu ảnh hưởng xấu đến kết quả ghép. Ghép tế bào gốc ngay từ thời điểm lui bệnh lần 1 có xu hướng cho xác suất sống toàn bộ cao hơn. Khi lựa chọn mẫu máu dây rốn, liều tế bào có nhân, liều tế bào CD34 và mức độ hòa hợp HLA càng cao thì khả năng hồi phục tế bào máu càng nhanh và kết quả ghép càng tốt. Bệnh ghép chống chủ cấp là yếu tố tiên lượng xấu, trong khi sự bất đồng nhóm máu ABO không ảnh hưởng đến xác suất sống toàn bộ. Sự tự phục hồi tế bào lympho T tự thân của bệnh nhân có liên quan đến thải ghép, và việc sử dụng ATG trong phác đồ điều kiện hóa có thể giúp khắc phục và hạn chế thải ghép.

Tuy nhiên, nghiên cứu có một số hạn chế về cỡ mẫu nhỏ và thời gian theo dõi ngắn (1 năm), dẫn đến các kết quả mang tính xu hướng. Do đó, khuyến nghị tiếp tục nghiên cứu với cỡ mẫu lớn hơn và thời gian theo dõi dài hơn để khẳng định rõ hơn hiệu quả và vai trò của các yếu tố ảnh hưởng, đặc biệt là vai trò dự phòng thải ghép của ATG.

Mục lục chi tiết:

MỤC LỤC

• ĐẶT VẤN 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