子-母微量嵌合体基础上同胞间非T淋巴细胞去除HLA半相合造血干细胞移植一例  

Non-T-cell-depleted HLA haplo-identical hematopoietic stem cell transplantation from sibling donor based on the feto-maternal microchimerism: report of one case

作　　者：王荧[1] 吴德沛[1] 孙爱宁[1] 傅 唐晓文[1] 朱子玲[1] 何军[1] 

机构地区：[1]苏州大学附属第一医院血液内科,215006

出　　处：《中华器官移植杂志》2006年第7期431-433,共3页Chinese Journal of Organ Transplantation

基　　金：卫生部项目资金资助(WKJ2004);江苏省社会发展基金资助(BS2002012);江苏省135重点学科资助(135LC0407)

摘　　要：目的为扩大供者来源,探讨在子-母微量嵌合体基础上同胞间非T淋巴细胞去除(Non-TCD)HLA半相合造血干细胞移植的可行性。方法受者的原发病为慢性粒细胞白血病(CML)急性淋巴细胞病变,供者为其胞弟,供、受者HLA有3个抗原不同,经套式序列特异引物聚合酶链反应技术检测,供者微量嵌合体阳性。采用全身照射、司莫司汀、阿糖胞苷、环磷酰胺及兔源抗胸腺细胞球蛋白等对受者进行预处理;采用环孢素A、霉酚酸酯及甲氨蝶呤预防移植物抗宿主病(GVHD)。结果移植后受者的外周血中性粒细胞>0.5×109/L和血小板>20×109/L的时间分别为11、18d,骨髓检查显示增生活跃,粒细胞系、红细胞系形态和比例正常;1、2、3、6个月和1年时完全供者型嵌合>90%。术后发生Ⅱ度急性GVHD及慢性局限性GVHD,经调整免疫抑制治疗方案后缓解。受者现基本恢复正常生活。结论子-母微嵌合体阳性的HLA半相合同胞可作为Non-TCD造血干细胞移植的供者。Objective To explore the feasibility of non-T-cell-depleted （Non-TCD） HLA haploidentical hematopoietic stem cell transplantation （HSCT） from noninherited maternal antigen （NIMA）-mismatched sibling donor based on the feto-maternal microchimerism （FMc） for expansion of donor availability. Methods A male patient with chronic myelogenous leukemia in lymphoid blast crisis received HLA haplo-identical three-loci mismatched bone marrow transplantation from his sibling. The pairs were mismatched in NIMA. FMc was detected by nested-polymerase chain reaction in the donor. Conditioning regimen included total body irradiation, Me-CCNU, cytarabine, cyclophosphamide and anti-thymocyte globulin. The prophylaxis against graft-versus-host disease （GVHD） consisted of cyclosporin, mycophenolate mofetil with short-term methotrexate. Results The patient achieved engraftment successfully with an absolute neutrophil count 〉0. 5 × 10^9/L on day 11 and a platelet count 〉20 × 10^9/L on day 18 after transplantation. Analysis of bone marrow demonstrated hypercellular, normal morphology and proportion of hematopoietic system, along with full donor chimerism （〉90%） on months 1, 2, 3, 6 and 12. An acute GVHD of grade 11 and chronic limited GVHD developed, but improved with modification of immunosuppressive therapy. The patient has regained normal lives now. Conclusion NIMA-mismatched sibling with FMc may be a suitable donor for Non-TCD HLA haplo-identical HSCT.

关 键 词：造血干细胞移植 聚合酶链反应 嵌合体 

分 类 号：R733.71[医药卫生—肿瘤]