ABO血型主次不合非血缘异基因外周血干细胞移植的临床研究

Clinical investigation on major and minor ABO-incompatible unrelated-donor peripheral blood stem cell transplantation for patient with ALL

目的确保重庆市首例ABO血型主次不和非血缘异基因外周血干细胞移植(URD-PBSCT)治疗急性淋巴细胞白血病成功。方法对接受ABO血型主次不和非血缘异基因外周血干细胞移植患者的植入效果、血型转换,以及移植近远期并发症进行观察和综合分析。结果患者造血迅速重建,中性粒细胞>0.5×109/L、血小板>20×109/L的时间分别为+11d、+16d;移植+20d血型鉴定可检出供者血型(B型红细胞),之后B型红细胞比例逐渐增高,至移植+73d全部转换为B型红细胞;血清抗A凝集素逐渐升高,抗B凝集素逐渐下降直至完全消失。经STR复检证实患者造血为供者型。移植过程中未见移植物抗宿主病(GVHD)、肝静脉闭塞病(VOD)等严重并发症;移植后复查骨髓提示持续完全缓解。结论ABO血型主次不合非血缘异基因外周血造血干细胞移植治疗血液病疗效肯定。

Objective To ensure success of maior and minor ABO-incompatible unrelated-donor peripheral blood stem cell transplantation （URD-PBSCT） for the patient with ALL at the first time in Chongqing. Methods To observe and compositely analysis implant effect, blood type transform and near/long-term complication of maior and minor ABO-incompatible URD-PBSCT. Results The patient was engrafted and hematopoieteic reconstitution was rapid ： the mean days of ANC recovery were 13d （up to 0.5 × 10^9/L） and PLT were 16d （up to 20× 10^9/L）, Donor＇s B-type red blood cell was detected after 20d, and its proportion increased gradually, Patient blood type completely transformed B type after 73d, Serum anti-A agglutinin increased gradually, On the contrary,serum anti-B agglutinin decreased gradually even completely vanish, It was confirmed that the patient haemopoiesis was donor origin by STR method, The acute GVHD and VOD were not seen and ALL was continued complete remission, Conclusion Major and minor ABO-incompatible URD-PBSCT is an effective therapeutic option for leukemia patients.