非去T细胞半相合造血干细胞移植术后植入失败的初步分析  

Preliminary analysis on graft failure after non-T-cell depleted haploidentical hematopoietic stem cell transplantation

作　　者：顾斌[1] 陈广华[1] 马骁[1] 傅琤琤[1] 韩悦[1] 唐晓文[1] 金正明[1] 苗瞄[1] 仇惠英[1] 孙爱宁[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院,江苏省血液研究所,卫生部血栓与止血重点实验室,血液学协同创新中心,215006

出　　处：《实用医学杂志》2016年第20期3401-3404,共4页The Journal of Practical Medicine

基　　金：江苏省科教兴卫工程-临床医学中心(编号:ZX201102);国家临床重点专科建设项目;国家高技术研究发展计划(863计划)课题(编号:2012AA02A505);国家自然科学基金项目(编号:81300444);江苏省自然科学基金(编号:BK20130273)

摘　　要：目的:总结非去T细胞半相合造血干细胞移植术(HCT)后植入失败的临床特征,并探讨其原因与治疗方案。方法:回顾性分析2012年1月至2013年12月期间我院实施非去T细胞半相合HCT的174例患者,移植前监测患者外周血供体特异性HLA抗体(DSA),阳性者给予丙种球蛋白或血浆置换。结果:3例急性髓细胞白血病患者发生植入失败,发生率为1.72%。1例原发性植入失败给予同胞半相合二次HCT后仍未植入,白血病未复发,但血象三系持续低下,二次移植后8月死于肺部感染。2例继发性植入失败,一例给予粒细胞集落刺激因子(G-CSF)动员的供体外周血单个核细胞(PBMNC)输注后16 d获得完全植入,至今无病存活30个月;另一例发生植入失败前监测到DSA阳性,平均荧光强度(MFI)值15 000,给予美罗华后MFI转阴,并输注G-CSF动员的供体PBMNC,输注后14d获得再次完全植入,至今无病存活41个月。结论:植入失败是非去T细胞半相合HCT少见却致命的并发症,美罗华后输注供体PBMNC是治疗DSA相关性植入失败的有效措施,值得进一步研究。Objective To summarize the clinical features of graft failure（GF）after non-T-cell depleted haploidentical hematopoietic stem cell transplantation（Haplo-HCT）, and to investigate the causes and treatment.Methods A retrospective analysis was carried out on 174 patientswho accepted the non-T-cell depleted HaploHCT from Jan 2012 to Dec 2013. The patients′ donor specific anti human leukocyte antigen antibodies（DSA）from the peripheral blood serum were detected and those DSA positive patients were treated by immunoglobulin or plasma exchange before transplatation. Results A total of three patients with acute myeloid leukemia got GF,the incidence rate was 1.72%. The patient with primary GF was given a second Haplo-HCT, but did not get implanted with leukemia remission and three lineages persistently low, he was died of pulmonary infection eight monthes after the second transplant. One of the secondary GF patients was given peripheral blood mononuclear cells（PBMNCs） mobilized by granulocyte colony stimulating factor（G-CSF） from the donor, and got full donor chimerism on day 16 after infusion. The disease-free survival has been for 18 months. The other case was found that DSA was positive, the mean fluorescence intensity（MFI） value was 15000, then Rituximab and PBMNCs mobilized by G-CSF were administrated successively. On day 14 after infusion the partient got full donor chimerism,and MFI turned negative. The patient has been disease-free survival for 41 months. Conclusion Graft failure is a rare but fatal complication after non-T-cell depleted Haplo-HCT, Rituximab followed by PBMNCs are effective measures for DSA related GF, as were worthy of further study.

关 键 词：非去T细胞 半相合造血干细胞移植 植入失败 

分 类 号：R457.7[医药卫生—治疗学]