亲缘间单倍体造血干细胞移植治疗白血病4例  

Related haploidentical hematopoietic stem cell transplantation for leukemia in four cases

作　　者：陈晓霞[1] 王智明[1] 罗贤生[1] 徐丹丹[1] 李兴[1] 雷美清[1] 

机构地区：[1]中南大学湘雅医学院附属海口市人民医院血液科,海南省海口市570208

出　　处：《中国组织工程研究与临床康复》2010年第19期3585-3588,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：2005年海南省自然科学基金项目(80571);课题名称"健康供者外周血造血干细胞动员及采集时机的探讨";2008年海南省自然科学基金项目(30869)~~

摘　　要：背景:建立及维持非血缘供者库需要大量投资,而亲属部分相合的供者则不需要特殊费用,有更强的可操作性。目的:评估亲缘间半相合造血干细胞移植治疗白血病的疗效。方法:选取2002-11/2008-03中南大学湘雅医学院附属海口市人民医院血液科住院患者4例,均进行HLA单倍体相合亲缘供者造血干细胞移植。采用改良的Bu/CY预处理方案:阿糖胞苷2.0~3.0g/(m2?d)×2d,持续24h静滴;马利兰4mg/(kg?d)×3d;环磷酰胺50mg/(kg?d)×2d;甲基环已亚硝脲25mg/(m2?d)×1d;抗胸腺细胞球蛋白25mg/(kg?d)×4d。在改良方案的基础上加大阿糖胞苷剂量1倍,且改为持续24h静滴,使预处理强度增加,促进造血干细胞持久植入。移植物抗宿主病预防:在经典的甲氨蝶呤方案基础上将环孢素A及霉酚酸酯提前至-7d(回输干细胞前为-)使用。患者移植前后进行ABO血型及DNA检测。结果与结论:①移植后造血重建检测:4例患者均获得造血重建,未发生预处理相关死亡。造血于细胞移植后-3^+7d白细胞降为0,并持续2~14d,+12^+20d白细胞>1.0×109L-1,+20^+51d血小板>20×109L-1。②移植物抗宿主病的发病情况:4例患者移植物抗宿主病Ⅳ级(肠道)1例,出现急性移植物抗宿主病Ⅱ级(肠道)1例,急性移植物抗宿主病Ⅱ级(皮肤)1例。提示随着预处理方案、移植物抗宿主病预防方案的优化,亲缘间单倍相合造血干细胞移植治疗白血病安全有效。BACKGROUND：A large amount of investment is needed to establish and maintain an unrelated donor database.Partial matched donors do not need special cost,with strong manipuility.OBJECTIVE：To evaluate the efficacy of haploidentical（from family member donors） hematopoietic stem cell transplantation for leukemia.METHODS：Four patients were enrolled at the Department of Hematology,Haikou Municipal People＇s Hospital,Affiliated to Xiangya School of Medicine,Central South University from November 2002 to March 2008.All patients received HLA haploidentical（from family member donors） hematopoietic stem cell transplantation.Modified Bu/CY pretreatment was utilized：cytarabine 2.0-3.0 g/（m2？d）×2 d,for 24 consecutive hours via the vein;myleran 4 mg/（kg？d）×3 d;cyclophosphamide 50 mg/（kg？d）×2 d;methyl-cyclohexyl nitrosourea;25 mg/（m2？d）×1 d;antithymocyte globulin 25 mg/（kg？d）×4 d.We had increased cytarabine dose twice,and changed to a 24-hour vein infusion,so that pre-processing was strengthened,which promoted a lasting hematopoietic stem cell implantation,based on the modified program.Graft-versus-host disease prevention：cyclosporin A and mycophenolate mofetil would be used and advanced to minus 7 days（one day before stem cell transfusion is minus 1） based on the classic methotrexate regimen.The ABO blood type and DNA were detected in patients before and after transplantation.RESULTS AND CONCLUSION：Detection of hematopoietic reconstitution after transplantation：All four patients had received hematopoietic reconstitution,with no pre-processing-related death.The leukocytes reduced to 0 after-3 to ＋7 days of hematopoietic stem cell transplantation,and for 2-14 consecutive days,＋12 to ＋20 days leukocytes 1.0 × 109/L,＋20 to ＋51 days platelets 20×109/L.Incidence of graft-versus-host disease：GVHD Ⅳ grade（intestinal tract） was found in 1 case,acute graft-versus-host disease grade Ⅱ（intestinal tract） in 1 case,and acute graft-versus-host disease grade

关 键 词：造血干细胞移植 移植预处理 白血病 淋巴瘤 

分 类 号：R394.2[医药卫生—医学遗传学]