HLA不全相合无血缘关系脐血移植治疗急性白血病

Treatment of one case junior acute non-lymphoblastic lekemia by two units HLA-mismatched unrelated umbilical cord blood transplantation

目的 :探讨HLA不全相合无血缘供者脐血移植 (UCBT)治疗血液系统恶性肿瘤造血重建、移植相关并发症的发生和生存情况。方法 :对 1例 15岁女性急性非淋巴细胞白血病 (ANLL)患者进行HLA 1个位点不相合2份UCBT。预处理方案 :采用白消安、环磷酰胺 (BU/CTX)方案 ,同时应用抗胸腺细胞球蛋白 (ATG)和Daclizumab(赛尼哌 ,zenapax)。移植物抗宿主病 (GVHD)的预防采用环孢菌素A(CsA)联合短程甲氨蝶呤 (MTX)和霉酚酸酯(MMF)方案。移植有核细胞数 (NC)为 4 .9× 10 7/kg ,CD34+ 细胞为 5 .36× 10 5/kg。结果 :中性粒细胞绝对计数 >0 .5× 10 9/L的时间为移植后第 15天 ;血小板计数 >5 0× 10 9/L的时间为移植后第 37天 ;全血细胞恢复正常的时间为移植后第 4 2天。移植后第 2 1天DNA指纹图提示供者型。受者已无病生存 2 0 0d。结论 :HLA 1个位点不相合的UCBT是可行的 ,对于体重量大的受者 2份脐血移植 (CBT)是可行的。

Objective:To explore the engraftment, Survival and transplantation-related complications of HLA one locus mismatched unrelated umbilical cord blood transplantation for the treatment of hematological malignancies. Method: A 15 years old girl with acute non-lymphoblastic leukemia received two units HLA-mismatched unrelated umbilical cord blood transplantation. The conditioning regimens were BU-CTX plus ATG and daclizumab GVHD prophylaxis regimen consisted of cyclosporine (CsA) and short course methotrexate (MTX) and mycophenolate mofetil (MMF).The patient received 4.9×107nucleated cells/kg, with 5.36×105 CD34+ cells/kg. Result:ANC> 0.5×109/L occurred at day 15, BPC >50×109/L at day 37, the peripheral blood counts normalization at day 42 and the DNA fingerprinting showing engraftment at day 21, The recipient had survived for 200 days. Conclusion: HLA-mismatched unrelated umbilical cord blood transplantation is a feasible procedure to cure a significant proportion of junior with leukemia. Two units of CBT can be used for patients with high weight if the cell number of one unit is not enough.