脐血移植治疗急性白血病的临床研究

Clinical Study of Umbilical Cord Blood Hematopoietic Stem Cell Transplantation for Acute Leukemia Therapy

目的 探讨同胞和非血缘关系脐血造血干细胞移植治疗急性白血病的疗效和相关并发症。方法 4例急性白血病患者分别行同胞和非血缘关系脐血移植各 2例。预处理方案 :以BUCY为基础化疗方案。移植物抗宿主病(GVHD)的预防 :采用环孢素A和短程甲氨喋呤方案。脐血细胞回输 :输注脐血有核细胞中位数为 3 5 5× 10 7/kg(2 2 0× 10 7～ 4 86× 10 7/kg) ,CD34+ 细胞中位数为 2 80× 10 5/kg (0 93× 10 5～ 3 85× 10 5/kg)。结果 4例患者脐血造血干细胞经DNA多态性分析证实植活。出现急性Ⅱ度和Ⅳ度GVHD各 1例 ,加强免疫抑制治疗后好转。 3例患者仍无病存活 ,生存时间分别为 36个月、 2 4个月、 2 0个月 ,1例患者移植后 7个月白血病复发。结论 脐血是造血干细胞的良好来源 ,脐血移植是治疗急性白血病的一种有效方法。

Objective To study the therapeutic effects and associated compl ications of sibling and unrelated human umbilical cord blood hematopoietic stem cell transplantation in the treatment of acute leukemia. Methods Of the 4 patients with acute leukemia, 2 received sibli ng umbilical cord blood transplantation and the other two were subjected to unre lated umbilical cord blood transplantation. The pretreatment regimens were based on BUCY2. The aGVHD was prevented by ciclosporin A and short-term MTX regimen. The median of the transfused umbilical cord nucleated cells was 3.55×107/kg (2.20×107—4.86×107/kg) and that of the CD34+ cells was 2.80×105/k g (0.93×105—3.85×105/kg). Results All these patients succeeded in transplantation identif ied by DNA polymorphism. Two patients got Ⅱ°and Ⅳ°GVHD respectively and both improved after enhancing immunosuppressing therapy. Three of all obtained leuke mia free survival and their survival times were 36 months, 24 months, 20 months respectively. One patient relapsed 7 months after cord blood transplantation. Conclusion Human umbilical cord blood is a good source of hemat opoietic stem cells. Human umbilical cord blood hematopoietic stem cell transpla ntation is effective for acute leukemia therapy.