非清髓无关供体外周血干细胞移植治疗重型再生障碍性贫血  

The treatment of nonmyeloablative unrelated peripheral blood stem cell transplantation for severe aplastic anemia

作　　者：肖毅[1] 张义成[1] 张东华[1] 黄亮[1] 周剑锋[1] 孙汉英[1] 刘文励[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院血液科,武汉430030

出　　处：《临床内科杂志》2007年第5期328-330,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨无关供体造血干细胞移植治疗重型再生障碍性贫血(SAA)的方法和疗效。方法对1例SAA的患者进行了无关供体HLA高分辨4/6相合的外周血干细胞移植。采用环磷酰胺(100mg/kg)+氟达拉宾(150mg/m2)+抗人淋巴细胞球蛋白(100mg/kg)的非清髓性预处理后,回输粒细胞集落刺激因子(G-CSF)动员的外周血干细胞,共输注单个核细胞(MNC)6.77×108/kg,CD3+4细胞1.95×106/kg。预防移植物抗宿主病(GVHD)采用环胞菌素A(CsA)联合短疗程甲氨蝶呤(MTX)的基础上加用霉酚酸酯(MMF)的方案。结果患者移植后造血恢复顺利,于移植后第6天WBC植入,第8天PLT植入,第30天行患者骨髓STR-PCR检测显示为完全供者的基因型,第150天血型转变为供者型(O→A)。未发生急性GVHD(aGVHD)及慢性GVHD(cGVHD),随访至移植后8个月,造血功能恢复良好,仍在继续随访中。结论以氟达拉宾、环磷酰胺和抗人淋巴细胞球蛋白组成的非清髓性预处理方案用于无关供体外周血干细胞移植治疗SAA,能够获得稳定的植入,且并发症少,是有效移植方法之一。Objective To explore the treatment and effect of unrelated hematopeietic ceil transplantation for severe aplastic anemia （SAA）. Methods 1 patient with SAA received nonmyeloablative conditioning regimens of cyclophosphamide（100mg/kg） ＋ fludarabine（ 150mg/m^2 ） ＋ antithymocyte globulin（ATG） （100mg/kg） ,G-CSF mobilization,peripheral blood stem cell at 2 locus mismatched transplantation. MNC 6.77 × 10^8/kg and CD34^＋ cell 1.95× 10^6/kg were infused. Graft versus host disease （GVHD） prophylaxis consisted of cyclosperin-A （ CsA）, methotrerate （MTX） and mycophenolate mofetil （ MMF ）. Results The hematopeietic stem cell was transplanted successfully. The WBC and PLT were graftted respectively in ＋6d and ＋8d. The DNA fingerprinting showed engraftement by short tadom repeated-PCR （STR-PCR） in ＋30d. The blood type was changed into the type of donor （O→A） in ＋ 150d. None of the acute GVHD （aGVHD） and chronic GVHD （cGVHD） were observed. The patient was followed for 8 months after allo-HSCT,and the function of hemopoiesis was well. Conclusions The treatment of unrelated HSCT with fudarabine, cyclophosphamide and ATG nonmyeloablative conditioning allowed for good engraftment without serious complications for SAA without HLA-identical sibling.

关 键 词：非清髓 无关供体 造血干细胞 重型再生障碍性贫血 

分 类 号：R55[医药卫生—血液循环系统疾病]