脐血移植治疗37例儿童恶性血液病的临床研究-单中心经验  

Clinical effect of umbilical cord blood transplantation in 37 pediatric patients with hematologic malignancies:a single-center experience

作　　者：栾佐[1] 唐湘凤[1] 吴南海[1] 徐世侠[1] 章波[1] 王凯[1] 杜宏[1] 

机构地区：[1]海军总医院儿科,北京100048

出　　处：《中国当代儿科杂志》2014年第7期714-719,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨脐血造血干细胞移植(UCBT)治疗儿童恶性血液病的疗效。方法回顾性分析接受UCBT的37例恶性血液病患儿的临床资料,包括急性淋巴细胞性白血病14例,急性髓细胞性白血病9例,幼年粒单细胞白血病5例,慢性粒细胞白血病和骨髓增生异常综合征各3例,急性混合型白血病2例,淋巴肉瘤性白血病1例。其中34例非血缘相关,3例血缘相关。HLA配型6/6相合5例,5/6相合12例,4/6相合11例,3/6相合9例。移植中位年龄5.7岁,中位体重20 kg。结果中性粒细胞和血小板植入中位天数分别是12 d和25 d,植入率分别为95%和78%。中性粒细胞植入率与CD34+细胞数呈正相关(P=0.011)。血小板植入率与CD34+细胞数和有核细胞数均有关(分别P=0.001、0.014)。急性移植物抗宿主病(GVHD)的发生率为49%,慢性GVHD为11%。随访中位时间54个月,5年移植相关病死率、总生存率和无病生存率分别为27%、57%和41%。结论脐血移植是快速获得的造血干细胞来源之一,为恶性疾病患儿争取了治疗时间。Objective To evaluate the clinical effect of umbilical cord blood transplantation（UCBT） in children with hematologic malignancies. Methods A retrospective analysis was performed on the clinical data of 37 pediatric patients with hematologic malignancies that consisted of 14 cases of acute lymphocyte leukemia, 9 cases of acute myeloid leukemia, 5 cases of juvenile myelomonocytic leukemia, 3 cases of chronic myeloid leukemia, 2 cases of acute mixed leukemia, 3 cases of myelodysplastic syndrome, and 1 case of lymphosarcomatous leukemia. Thirty-seven children with hematologic malignancies received UCBT from unrelated donors（34 cases） and related donors（3 cases）. Grafts were 6/6 HLA-matched in 5 cases, 5/6 HLA-matched in 12 cases, 4/6 HLA-matched in 11 cases, and 3/6 HLAmatched in 9 cases. Before transplantation, these patients received rabbit antithymocyte globulin-containing conditioning regimen. The myeloablative conditioning regimen was given in 36 cases and the reduced-intensity conditioning regimen in one case. The median age of transplantation was 5.7 years, and the median weight was 20 kg. The grafts that contained a median of 6.2×10^7 total nucleated cells（TNC）/kg and 2.7×10^5 CD34^＋ cells/kg were infused. Results The median times to neutrophil engraftment and platelet engraftment were 12 days and 25 days, respectively, and the rates of neutrophil engraftment and platelet engraftment were 95% and 78%, respectively. The rate of neutrophil engraftment was positively correlated with the number of CD34^＋ cells（P=0.011）, while the rate of platelet engraftment was correlated with the numbers of CD34^＋ cells and TNC（P=0.001; P=0.014）. The incidence rates of acute and chronic graft-versushost disease were 49% and 11%, respectively. The median follow-up was 54 months. The 5-year transplant-related mortality, overall survival, and disease-free survival were 27%, 57.4% and 41%, respectively. Conclusions UCBT is an alternative source of hematopoietic stem cells for patients with hematologi

关 键 词：脐血移植 恶性血液病 儿童 

分 类 号：R733.7[医药卫生—肿瘤]