二次移植成功治疗急性白血病单倍体造血干细胞移植植入失败  

Successful treatment of acute leukemia by secondary transplantation after the first haploidentical hematopoietic stem cell transplantation failure

作　　者：黄克智[1] 李益清[1] 谢少凡 肖洁[1] 杨文娟 谢双锋[1] 马丽萍[1] 聂大年[1] Huang Kezhi;Li Yiqing;Xie Shaofan;Xiao Jie;Yang Wenjuan;Xie Shuangfeng;Ma Liping;Nie Danian(Department of Hematology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院血液内科、广东省恶性肿瘤表观遗传与基因调控重点实验室,广州510120

出　　处：《器官移植》2023年第3期427-434,共8页Organ Transplantation

基　　金：国家自然科学基金(82000153);广东省科学技术厅农村科技特派员重点派驻任务(KTP2020324)。

摘　　要：目的探讨急性白血病患者首次单倍体造血干细胞移植后植入失败的二次移植治疗策略。方法2例急性白血病患者首次单倍体造血干细胞移植的2例供者均伴有地中海贫血,分别采集CD34+细胞2.57×10^(6)/kg和1.99×10^(6)/kg,首次单倍体造血干细胞移植植入失败。二次移植更换为非地中海贫血供者,分别采集CD34+细胞4.28×10^(6)/kg和5.75×10^(6)/kg,采用减低剂量氟达拉滨(Flu)+白消安(Bu)+抗胸腺细胞球蛋白(ATG)预处理方案行二次移植。结果2例患者二次移植中性粒细胞和血小板植入时间分别为+12 d和+10 d、+10 d和+10 d。截止至末次随访时间(分别为二次移植+1062 d、+265 d),2例患者原发病均完全缓解,无明显移植并发症。结论减低剂量预处理的二次移植能够成功治疗急性白血病单倍体造血干细胞移植植入失败。Objective To evaluate the feasibility of secondary transplantation for patients with acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation.Methods Two acute leukemia patients underwent the first haploidentical hematopoietic stem cell transplantation from two donors with thalassemia,and the number of collected CD34+cells was 2.57×10^(6)/kg and 1.99×10^(6)/kg per donor,respectively.The first haploidentical hematopoietic stem cell transplantation failed.Secondary transplantation was performed from two non-thalassemia donors,and the number of collected CD34+cells was 4.28×10^(6)/kg and 5.75×10^(6)/kg per donor,respectively.A reducedintensity conditioning regimen consisting of fludarabine(Flu),busulfan(Bu)and antithymocyte globulin(ATG)was adopted for the secondary transplantation.Results For two recipients,the time of secondary transplantation of neutrophil and platelet was+12 d and+10 d,+10 d and+10 d,respectively.Up to the final follow-up(+1062 d and+265 d after secondary transplantation),the primary diseases of both two recipients have been completely relieved without evident post-transplantation complications.Conclusions Secondary transplantation with reduced-intensity conditioning regimen may successfully treat acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation.

关 键 词：二次移植 单倍体造血干细胞移植 植入失败 急性白血病 地中海贫血 移植物抗宿主病 环磷酰胺 抗胸腺细胞球蛋白 

分 类 号：R617[医药卫生—外科学] R551[医药卫生—临床医学]