无关供者PBSC联合MSC移植治疗重型再生障碍性贫血Ⅱ型的效果观察  

Co-transplantation of unrelated donor peripheral stem cells combined with cord mesenchymal stem/stroma cells for severe aplastic anemia Ⅱ patients

作　　者：周健 符粤文 梁利杰 张莉 王倩 韩利杰 祖璎玲 喻凤宽 房佰俊 魏旭东 宋永平 

机构地区：[1]郑州大学附属肿瘤医院,450008

出　　处：《中华器官移植杂志》2016年第4期193-197,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨脐血间充质干细胞（MSC）联合无关供者外周血造血干细胞（URD-PBSC）移植治疗重型再生障碍性贫血（SAA）Ⅱ型的临床效果和安全性。方法回顾性分析2010年3月至2015年6月接受脐血MSC联合URD-PBSC移植的11例SAAⅡ型受者的临床资料。11例受者均经血常规、骨髓细胞形态学、骨髓活检和染色体等检查，明确诊断为SAAⅡ型，原发病诊断到移植的时间中位数为49个月（25-194个月）。所有受者经预处理后进行PBSC联合MSC移植，PBSC移植时输注单个核细胞中位数为11．36×10^8／kg，输注CD34＋细胞中位数为3．46×10^6／kg；PBSC输注24h后输注MSC，输注MSC中位数为1．41×10^6／kg。移植后采用环孢素A（或他克莫司）＋短疗程甲氨蝶呤＋吗替麦考酚酯预防移植物抗宿主病（GVHD）。观察受者移植后造血功能重建情况，移植相关并发症发生情况，以及存活状况。结果移植后，1例受者出现早期移植排斥反应，其余10例受者移植后造血功能均获得重建，未发生输注MSC不良反应。中性粒细胞和血小板植入时间中位数分别为14d（10-23d）和19d（11～38d）。移植后发生I度急性GVHD3例，Ⅲ度急性GVHD1例；1例并发广泛性慢性GVHD。发生肺部真菌感染4例，巨细胞病毒（CMV）血症8例，1例发展为CMV肺炎，EB病毒血症6例，出血性膀胱炎3例。随访时间中位数为26个月（8-74个月），10例受者存活，9例脱离输血，预计5年总体存活率为（90．9±8．7）％，无病存活率为（81．8±11．6）％。结论脐血MSC联合URD-PBSC移植治疗SAAⅡ型是安全、可行的，移植效果良好。Objective To-observe the efficacy and safety of co-transplantation of unrelated donor peripheral stem cell transplant （URD PBSCT） combined with umbilical mesenchymal cells （MSCs） for severe aplastic anemia （SAA） Ⅱ patients. Method We retrospectively analyzed the clinical data of 11 patients with SAA Ⅱ undergoing URD PBSCT with co-transfusion of MSCs from March 2010 to June 2015. Eleven recipients were diagnosed by blood routine examination, chromosome, bone marrow morphology and biopsy. The median time from diagnosis to transplantation was 49 months （range 25-194 months）. All recipients underwent co-transplantation of PBSC and MSCs after conditioning regimen. The median reinfusion quantity of mononuclear cells and CD34 positive cells was 11.36 × 10^8/kg and 3. 46× 10^6/kg in PBSCT, respectively. Interval from PBSC infusion to MSCs infusion was 24 h, and the median number of MSCs was 1.41 × 10^6/kg. Graft-versus-host disease （GVHD） was prevented by methotrexate, MMF and cyclosporine A or taerolimus. The hematopoietic reconstitution, transplant-associated complications of these recipients and survival were monitored after transplantatiorL Result After transplantation, early graft rejection occurred in one patient. Hematopoiesis recovery was achieved in 10 patients. No adverse events were observed in MSCs transfusion. Median time to neutrophil and platelet engraftment was 14 （range10- 23） and 19 （range 11-38） days, respectively. The grade Ⅰ and Ⅱ acute GVHD occurred in 3 cases and 1 case, respectively. One recipient developed extensive chronic GVHD. Lung invasive fungal infections occurred in 4 recipients. Cytomegalovirus （CMV） and EBV viremia was observed in 8 and 6 patients, respectively. One of them had developed CMV pneumonia. Three cases developed hemorrhagic cystitis. During a median follow-up period of 26 （range 8-74） months, the estimated 5- year overall survival rate in the upfront cohort was （90. 9 ± 8. 7） %, and disease-free survival rate was （81.8 ±

关 键 词：再生障碍性贫血Ⅱ型 造血干细胞移植 无关供者 间质干细胞 

分 类 号：R556.5[医药卫生—血液循环系统疾病]