无血缘关系脐血细胞移植治疗小儿恶性淋巴瘤一例  

No-genetic-connection cord blood transplantation in treatment of pediatric lymphoma

作　　者：李桂芳[1] 王学之[1] 翟群[1] 甘戈[1] 骆益宙[1] 廖辉[1] 温宏升[1] 江志生[1] 

机构地区：[1]中国人民解放军第454医院肿瘤血液科,南京210002

出　　处：《中华器官移植杂志》2003年第1期47-49,共3页Chinese Journal of Organ Transplantation

摘　　要：目的　探讨无血缘关系脐血细胞移植治疗小儿恶性淋巴瘤的有效性、可行性。方法　对一患淋巴母细胞性淋巴瘤的女性患儿施行无血缘关系、HLA不全相合、ABO血型不合的脐血细胞移植。术前预处理方案为 :环磷酰胺 1 2 0mg/kg ,足叶乙甙 1 8mg/kg ,兔抗人胸腺细胞球蛋白 2 .5mg·kg- 1 ·d- 1 × 3d ,全身放疗 8Gy。共移植脐血有核细胞 3 .33× 1 0 7/kg(52ml)。结果　患者移植后造血功能获得重建 ,移植后 33d ,中性粒细胞 >0 .5× 1 0 9/L ,34d时血小板 >2 0× 1 0 9/L ,57d时受者的血型由O型转变为供者的A型 ,DNA指纹图显示患儿的基因与供者一致。术后三碘甲状腺原氨酸 (T3)、甲状腺素 (T4 )一度下降 ,2个月后恢复到术前水平。甲胎蛋白 (AFP)术后升高 ,6个月后恢复正常。术后T淋巴细胞亚群下降 ,7个月后恢复正常水平。目前患者已无病存活 1 8个月 ,正常上学。结论　脐血是造血干细胞的良好来源 。Objective To find a new source of hematopoietic stem cell and investigate the availability of no genetic connection cord blood transplantation in treatment of pediatric lymphoma. Methods The patient was treated by allogeneic cord blood stem cell transplantation. After the all circumstance had been protected, high dose chemotherapy was applied in addition to total body irradiation. The pretreatment protol included: Cyclophosphamide 120?mg /kg+Etoposide 18?mg /kg+rabbit anti human thymus IgG 2.5?mg /kg every day×3 days+total body irradiation 8 Gy. Then 52?ml of A type (ABO) and a HLA site cord incoincidence blood was infused. For prevention of graft verse host disease (GVHD), anti human thymus globulin, cyclosporin A, methotrexate were intravenously infused. After transplantation, clinical characters and laboratory examinations including blood routine, T 3, T 4, AFP were examined. Results After transplantation, the hematopoietic function was reconstructed, ANC> 0.5 ×10 9/L after 33 days, and PLT>20×10 9/L after 35 days, the ABO blood type changed from O to type A after 57 days. The DNA fingerprint mark of recipes was same as donor's. T 3, T 4 had been followed up for 2 months, AFP for 6 months, subtype of T cell for 7 months till normal level. The patient has been followed up for 11 months and has lived a normal school life.Conclusion Cord blood is a good source of hematopoietic stem cell, and cord blood transplantation could replace the bone marrow transplantation in pediatrics sometimes.

关 键 词：恶性淋巴瘤 治疗 胎血 造血干细胞移植 儿童 病例报告 

分 类 号：R733.1[医药卫生—肿瘤]