HLA不全相合非血缘供者脐血移植治疗儿童急性淋巴细胞白血病

Treatment of One Case Childhood Acute Lymphobastic Leukemia by HLA-mismatched unrelated umbilical Cord Blood Transplantatation

目的 探讨HLA不全相合非亲缘供者脐血移植 (UCBT)治疗儿童急性淋巴细胞白血病及其移植相关并发症。方法 1例急性淋巴细胞白血病 (ALL)患儿进行HLA1个位点不合非亲缘供者的UCBT。预处理方案 :氟达拉滨 (Fludarabine) 30mg·kg-1·d-1× 5d ,环磷酰胺 (CTX) 6 0mg·kg-1·d-1× 2d ,马利兰 4mg·kg-1·d-1,抗胸腺球蛋白 (ATG兔抗 ) 3mg·kg-1·d-1× 3d。移植物抗宿主病 (GVHD)的预防采用环胞菌素 (CsA)加用骁悉 (MMF)和甲基强的松龙方案。移植有核细胞数 5 .2 4× 10 7/kg,CD34+细胞 2 .93× 10 5 /kg ,CFU GM0 .93× 10 5/kg。观察监测巨细胞病毒 (CMV)感染 ,更昔洛韦 (GCV)与磷甲酸钠联合应用。结果 移植后 2 8d造血重建 ,移植后 84d血型转为供者型 (B型 ) ,染色体检测转为供者 4 6XX ,移植后第 2 2d出现Ⅱ度急性GVHD。移植后第 2 2dDNA指纹图提示供者型。结论 UCBT造血重建快而稳定 ,移植相关并发症较少 ,急性GVHD严重程度较轻。HLA1个位点不合非亲缘供者的UCBT有效可行。

Objective To explore the hematopoietic reconstitution and transplantatation related complications of HLA one locus mismatched unrelated umbilical cord blood transplantatation for the treatment of one case childhood acute lymphoblastic leukemia(ALL). Methods A 12-year old patient(man)with ALL received HLA-mismatched unrelated umbilical cord blood transplantatation .The conditioning regimens Fludarabine plus BU-CTX and ATG.GVHD prophylaxis regimen consisted of cyclosporine(CsA) and mycophenolate mofetil(MMF).The patients received 5.26×107 nucleated cells/kg with 6.25×106 CD34+ cells/kg. CMV disease received antiviral treatment with ganciclovir and foscarnet,globulin and other supportive measures. Results Hematopoietic reconstitution obtained on 28 th day after UCBT.Chromosome analysis was showed in the type of 100%, 46:XX(G)on 84 th day after UCBT. The DNA fingerprinting showing engraftment at day 22.Grade Ⅱacute graft versus host disease (aGVHD)occurred at day 15.Conclusions The hematopoietic reconstitution in umbilical cord blood transplantatation were earlier and more durable.The transplantatation related complications were less and aGVHD were milder.