脐带造血干细胞移植治疗儿童恶性或非恶性疾病死亡分析  

Analysis of Cause of Death of Children with Malignant and Nonmalignant Diseases Treated with Umbilical Cord Blood Transplantation

作　　者：唐湘凤[1] 栾佐[1] 吴南海[1] 徐世侠[1] 黄友章[1] 王凯[1] 龚小军[1] 

机构地区：[1]中国人民解放军海军总医院儿科,北京100037

出　　处：《实用儿科临床杂志》2009年第3期185-186,219,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨脐带造血干细胞移植治疗儿童恶性或非恶性疾病后患儿的常见死亡原因。方法对本院采用脐带造血干细胞移植治疗的28例儿童恶性疾病或非恶性疾病患儿的临床资料进行回顾性分析,包括24例恶性疾病和4例非恶性疾病。3例行同胞脐血干细胞移植,25例行异基因脐带造血干细胞移植,其中HLA高分辨全相合、5个位点相合各10例,4个位点相合5例,3个位点相合3例。预处理均采用清髓性方案,7例ALL采用全身放疗/环磷酰胺/抗胸腺Ig,余21例采用白消安/环磷酰胺/抗胸腺Ig。于0d回输脐血有核细胞中位数为8.51(4.27～12.2)×107/kg,CD34+细胞的中位数为1.81(1.27～2.31)×105/kg。预防急性移植物抗宿主病均采用环孢素和小剂量甲泼尼龙,其中3例另加霉酚酸酯,1例加CD20单抗。随访4～86个月。结果28例行脐血造血干细胞移植的恶性或非恶性疾病儿童,存活16例(57.1%),死亡12例(42.9%)。死于感染7例(25.0%),其中间质性肺炎、真菌感染性肺炎各3例,病毒性肺炎1例;死于复发3例(10.7%);死于急性移植物抗宿主病2例(7.1%)。结论儿童恶性疾病的原发病复发是脐带造血干细胞移植后常见的死亡原因之一,感染是儿童恶性疾病和非恶性疾病行脐血造血干细胞移植后另一常见死亡原因。Objective To explore common causes of death in umbilical cord blood transplantation treating malignant and nonmalignant diseases in children. Methods Retrospective analysis was made on clinical data of 28 children with malignant and nonmalignant diseases treated with umbilical cord blood transplantation, including 24 children with malignant diseases and 4 children with nonmalignant diseases. Three cases underwent sibing umbilical cord blood and 25 cases were unrelated umbilical cord blood. Umbilical cord blood grafts were histocompatibility leukocyte antigen - matched（ n = 10） or histocompatibility leukocye antigen -mismatched at 1 （n = 10） or 2 （n = 5 ） or 3 （n = 3 ） loci. The pretreatment regimen was overall body irradiation, cyclophosphamide and antithymocyte globulin in 7 cases, busulfan, cyclophosphamide and antithymocyte globulin in 21 cases. The median dose of donor nucleated cell counts was 8.51 × 10^7/kg of recipient weight, and CD34^＋ cell counts was 1.81 × 10^5/kg of recipient weight. The prophylaxis of acute graft versus host disease was cyclosporine and methylpred- nisolone, including mycophenolate mofetil in 3 cases and antibody in 1 case. The follow - up was done from 4 to 86 months. Results In the 28 children with malignant and nonmalignant diseases treated with umbilical cord blood transplantation, 12 cases （42.9%） were dead after transplantation. Seven cases （25.0%） with pulmonary infection were dead, including 3 cases with interstitial pneumonia,3 cases with fungal infection pneumonia,and 1 case with viral pneumonia. Three cases （ 10.7% ） with relapse and 2 cases （7.1%） with acute graft- versus - host disease were dead. Conclusions Relapse of hematological malignance is one of death causes after cord blood transplantation. Infection is another common causes of death in malignant and nonmalignant diseases for cord blood transplantation.

关 键 词：脐带造血干细胞移植 死亡原因 间质性肺炎 儿童 

分 类 号：R730.5[医药卫生—肿瘤] R457.1[医药卫生—临床医学]