非血缘异基因外周血造血干细胞移植治疗急性粒细胞白血病一例

Unrelated peripheral blood stem cell transplantation for a patient with acute myeloid leukemia

目的：开展非血缘关系供者外周血造血干细胞移植（ＰＢＳＣＴ）对血液恶性肿瘤进行根治性治疗，并观察其长期造血重建和移植物抗宿主病（ＧＶＨＤ）及一些移植并发症。方法：选择ＨＬＡ相配非血缘关系的２６岁男性健康供者的外周血干细胞移植给１例急性粒细胞白血病第１次复发缓解后的１１岁男性患儿。预处理方案为分次全身６０Ｃｏ照射（８Ｇｙ）加环磷酰胺（１２０ｍｇ／ｋｇ）和足叶乙甙（３０ｍｇ／ｋｇ）。移植物抗宿主病预防用环孢霉素Ａ（ＣｓＡ）联合氨甲喋呤（ＭＴＸ）。移植单个核细胞为８．３×１０８／ｋｇ，ＣＤ３４＋细胞为１．０７９×１０８／ｋｇ，ＣＦＵ－ＧＭ为１．０９×１０６／ｋｇ。结果：＋１０天中性粒细胞达１．３０×１０９／Ｌ，＋１８天骨髓显示造血重建，＋２３天ＤＮＡＤ１Ｓ８０显示移植物植入成功，＋１２０天受者血型由ＡＢ型转为供者血型Ａ型。＋１１天出现Ⅰ度急性ＧＶＨＤ，＋１４３天出现慢性ＧＶＨＤ，分别用甲基泼尼龙和泼尼松控制。随访３００余天，患者情况正常。

Objective:To carry out unrelated donor peripheral blood stem cell transplantation for treatment of hematological malignancies,and to observe the persistent hematopoietic reconstitution and transplantation related complications.Methods:A 11 year old boy with acute myeloid leukemia,who was in second CR,received peripheral blood stem cell transplantation from a unrelated healthy adult donor.The conditioning regimen consisted of FTBI(8Gy),cyclophosphamide(120mg/kg) and Vp16(30mg/kg).The patient received 8.3×10 8 mononuclear cells/kg, 1.079×10 8 CD 34 + cells/kg and 1.09×10 6 CFU GM/kg.CsA and MTX were given for prophylaxis of aGVHD.Results:Engraftment with allogeneic peripheral blood stem cells was rapid,ANC reached 1.30×10 9/L on day 10 post transplantation,DNA D 1S 80 showed engraftment on day 23, and the blood type(AB) changed into the donor's(A) on day 120.The patient developed mild aGVHD (Ⅰ o) on day 11 and mild cGVHD on day 143,which were controlled by methylprednisolone and prednisone,respectively.Ten months after transplantation,the patient's blood counts were normal.Conclusion:Unrelated donor peripheral blood stem cell can maintain persistent hematopoiesis.