HLA相合无关供者造血干细胞移植联合脐带间充质干细胞输注治疗儿童重型再生障碍性贫血19例疗效及安全性研究  

Efficacy and security of matched unrelated donor hematopoietic stem cell transplant with transfusion of multipotent mesenchymal cells in pediatric severe aplastic anemia

作　　者：王玲[1] 王恒湘[1] 朱玲[1] 郑晓丽[1] 王志东[1] 闫洪敏[1] 丁丽[1] 韩冬梅[1] 

机构地区：[1]解放军空军总医院血液科,北京100142

出　　处：《中华血液学杂志》2016年第6期453-457,共5页Chinese Journal of Hematology

摘　　要：目的探讨HLA相合无关供者造血干细胞移植（MUD—HSCT）联合脐带间充质干细胞（MSC）输注治疗儿童重型再生障碍性贫血（SAA）的疗效及安全性。方法回顾性分析19例行MUD—HSCT联合MSC治疗的儿童SAA患者临床资料，观察移植后造血重建及移植相关并发症。结果19例患儿移植后均获得迅速造血重建，粒细胞中位植入时间为12（9～21）d，血小板中位植入时间为14（8～24）d，1例患儿于移植后4个月出现继发植入失败。9例患儿发生I度急性移植物抗宿主病（aGVHD），1例发生Ⅲ度aGVHD并于移植后6个月发生广泛型慢性移植物抗宿主病。CMV阳性15例，出血性膀胱炎2例。10例患儿移植后出现不同程度、不同部位的感染。中位随访时间为27（8-70）个月，19例患儿截至随访终点均无病存活，其中1例患儿于移植后4个月发生淋巴细胞增殖性疾病，接受利妥昔单抗联合化疗治疗后发生继发性植入失败，后接受以父亲为供者的单倍体造血干细胞移植成功植入。结论MUD．HSCT联合MSC输注治疗儿童SAA是安全有效的。Objective To observe the efficacy of matched unrelated donor hematopoietic stem cell transplant （HSCT） with transfusion of multipotent mesenchymal cells （MSC） in pediatric severe aplastic anemia （SAA）. Methods 19 children with SAA received matched unrelated donor HSCT with MSC, and the hematopoietic recovery and transplant-associated complications of these children were monitored. Results All patients achieved rapid hematopoietic reconstruction after HSCT, and the median durations to neutrophil and platelet recovery were 12 （9-21） days and 14 （8-24） days respectively, but delayed rejection occurred in one case four months after HSCT. 9 cases developed grade I acute graft-versus-host （aGVHD）, and one case grade III aGVHD and diffuse chronic graft-versus-host. Cytomegalovirus viremias were observed in 15 patients. 2 cases developed hemorrhagic cystitis, 10 children experienced infections. All the children were alive during a median following-up time of 27 （8-70） months, one of them developed LPD and received rituximab and chemotherapy, delayed rejection occurred in this patient four months after HSCT, Haplo-identical HSCT from his father as the donor was performed and achieved successful engraftment. Conclusion The matched unrelated donor HSCT with MSC in pediatric SAA was safe and effective.

关 键 词：贫血 再生障碍性 儿童 造血干细胞移植 间质干细胞 

分 类 号：R725.5[医药卫生—儿科]