异基因外周血造血干细胞移植治疗儿童重型再生障碍性贫血1例报告及文献复习  

Treatment of acute aplastic anemia with allogeneic blood stems transplantation:a case report and literature review

作　　者：王易[1] 柴忆欢[1] 何海龙[1] 李捷[1] 李健琴[1] 卢俊[1] 肖佩芳[1] 朱洁[1] 李祯萍[1] 朱玲琍[1] 

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215003

出　　处：《临床儿科杂志》2005年第11期797-799,共3页Journal of Clinical Pediatrics

摘　　要：目的评估异基因外周血造血干细胞移植治疗儿童重型再生障碍性贫血(再障)的疗效,探讨移植中合并巨细胞病毒感染治疗及其对长期造血重建的影响。方法患儿,男,12岁,供者为其胞姐,HLA配型完全相合。动员方案:G_CSF5μg/(kg·d)×6d。预处理方案:环磷酰胺(CTX)50mg/(kg·d)×4d,抗胸腺球蛋白3mg/(kg·d)×3d,氟达拉滨50mg/(kg·d)×3d。移植有核细胞数5.26×108/kg,CD34+细胞6.25×106/kg,CFU_GM10.21×105/kg。观察监测巨细胞病毒(CMV)感染,更昔洛韦(GCV)与可耐联合应用。结果移植后28d造血重建,移植后84d血型转为供者型(B型),染色体检测转为供者46XX移植后81d曾发生CMV感染,经早期、联合治疗后感染控制。未发生急、慢性移植物抗宿主病(GVHD),移植后骨髓象、血象正常。结论异基因外周造血干细胞移植可有效治疗重型再障,抗CMV感染治疗应早期、足量、联合、长期。Objective To evaluate the effectiveness of allogeneic peripheral blood stem cell transplantation （allo-PBSCT） on children with severe aplastic anemia （SAA） and explore the influence of cytomegalovirus （CMV） infection on matopoietic reconstitution. Methods A 12-year-old boy with SAA received allo-PBSCT from a HLA-compatible sibling donor. PBSCs mobilization regimen was G - CSF 5 μg/ （kg · d） × 6 d. The conditioning regimen was Fludarabine plus CTX and ATG. 5.26 μ 10^8/kg uncleared cells/kg and 6.25 μ 10^8/kg CD34 ＋ cells/kg were transplanted. CMV infection was treated with ganciclovir accompanied with foscarnet, globulin and other support measures. Results The patient obtained matopoietic reconstitution on the 28th day and the blood type of the donor＇ s on the 84th day after allo-PBSCT. Chromosomeanalysis showed that the chromosome was converted into 46XX, the donor＇ s chromosome. Conclusions allo-PBSCT is an effective therapy for SAA, and anti-CMV therapy should be used early, sufficient, combination and long-term.

关 键 词：异基因 造血干细胞移植 重型再生障碍性贫血 巨细胞病毒感染 

分 类 号：R725.5[医药卫生—儿科]