第三方骨髓间充质干细胞治疗异基因造血干细胞移植后继发性植入功能不良的疗效及安全性  

The outcome and safety of mesenchymal stem cells from bone marrow of a third party donor in treat- ment of secondary poor graft function following allogeneic hematopoietic stem cell transplantation

作　　者：刘晓丹[1] 范志平[1] 彭延文[2] 黄芬[1] 江千里[1] 张贤[1] 余国攀[1] 赵婕[1] 孙竞[1] 项鹏[2] 刘启发[1] 

机构地区：[1]南方医科大学附属南方医院血液科,广州510515 [2]中山大学干细胞与组织工程研究中心

出　　处：《中华血液学杂志》2012年第2期98-102,共5页Chinese Journal of Hematology

基　　金：广东省科技计划项目（2009A03020007）;广州市重大科技专项计划（2008Al-E4011-1）

摘　　要：目的评价第三方骨髓来源的间充质干细胞（Msc）对异基因造血干细胞移植（allo-HSCT）后继发性植入功能不良（PGF）的治疗效果及安全性。方法2007年4月至2010年9月入组5例allo-HSCT后发生继发性PGF的患者，分别在继发性PGF发生后中位第47（35-61）天接受体外扩增的第三方供者骨髓来源的Msc，以1×10^6细胞／kg的剂量单独治疗，若中性粒细胞绝对值（ANc）和PLT分别未达到〉1．5×10^9／L和〉50．0×10^9／L的造血恢复标准则于28-30d后接受第2次同等剂量的Msc输注。结果1例患者接受1次、4例患者接受2次Msc治疗，所有患者ANC和PLT均达到恢复标准，其达到恢复的中位时间在第1次MSC输注后的34（25-49）d与47（26-54）d。中位随访761（204-1491）d未见不良反应。3例患者分别在Msc治疗后第42、48、108天出现EBV血症，其中2例转化为EBV相关的移植后淋巴细胞增殖性疾病。结论第三方供者骨髓来源MSC对移植后继发性PGF有效，MSC是否会增加EBV感染及EBV相关性淋巴细胞增殖性疾病的发生率有待于进一步研究。Objective To evaluate the efficacy and safety of bone marrow-derived mesenchymal stem cells（MSC） from a third party donor for secondary poor graft function（PGF） following allogeneic hematopoiet- ie stem cell transplantation（allo-HSCT）. Methods Five patients with secondary PGF were treated with MSC at a dose of 1 x 106/kg body weight at a median of 47 days（35 to 61 ） after secondary PGF. MSC were derived from bone marrow（BM） of HLA-disparate third party donors, cultured in vitro and infused without HSC. If absolute neutrophil cell（ANC） and platelet counts（PLT） did not reach the standardization of 〉 1.5 x 109/L and 〉 50.0 x 109/L, respectively, within 28 - 30 days after the first MSC treatment, a second MSC treatment was required. Results MSC were infused once in one patient and twice in four patients with an interval of 28 to 30 days. All patients obtained ANC and PLT recovery at a median of 34 （25 to 49 ） days and 47 （ 26 to 54） days, respectively, without toxic side effects within follow-up periods of median 761 （204- 1491 ） days. Three patients developed Epstein-Barr virus（EBV） reactivation at 42, 48, 108 days after MSC infusion, re- spectively and two of the three eoverted to posttransplant lymphoproliferative disorders （ PTLD ）. Conclusion MSC from a third party donor are effective to patients with secondary PGF following allo-HSCT, whether it might increase the risk of EBV reactivation and EBV-assoeiated PTLD need further observation.

关 键 词：植入功能不良 继发性 造血干细胞移植 间质干细胞 第三方 

分 类 号：R457[医药卫生—治疗学]