非血缘异基因外周血造血干细胞移植治疗未缓解红白血病1例

Unrelated allogeneic peripheral blood hematopoietic stem cell transplantation for treatment of a non-remission acute leukemia patient

骨髓增生异常综合征转为红白血病的患者属高危白血病,常规化疗达到完全缓解的机率低且短期内复发率高,患者经包括氟达拉滨、去甲氧柔红霉素在内的多个方案化疗均无法完全缓解,所以尝试用造血干细胞移植治疗。受者为未缓解、合并溶血病例,且无人类白细胞抗原配型相合的血缘供者,如予Bu-CTX2方案预处理,单用环孢素A+甲氨蝶呤方案预防移植物抗宿主病,则面临并发症多、移植成功率低或移植后易复发等难题。因此采用了阿糖胞苷、马利兰、环磷酰胺、甲基环己亚硝脲及抗人淋巴细胞免疫球蛋白联合使用作为预处理方案,在环孢素A和短程甲氨蝶呤的基础上加小剂量霉酚酸酯预防急性移植物抗宿主病;虽然并发肝静脉闭塞病、Ⅱ度肠型急性移植物抗宿主病及迟发性出血性膀胱炎,但程度较轻,经予前列地尔、甲基强的松龙、碱化、水化尿液等措施后病情很快得到控制;移植后52d染色体核型分析转为供者型,移植后36个月随访受者仍无病存活,复查外周血像、骨髓像均正常。故对于未缓解急性白血病,采用改良Bu-CTX2预处理方案行异基因造血干细胞移植是有效的救治方法之一。

Myelodysplastic syndrome converted to erythroleukemia is a high-risk leukemia, which has a low rate of complete remission by conventional therapy and a high rate of short-term recurrence. Complete remission cannot be achieved by varied therapies including fludarabine and darubicin. Thus, hematopoietic stem cell transplantation was performed. Patients were not remission or combined with hematolysis, and there was not a donor coincided with human leukocyte antigen matching. If after Bu-CTX2 preconditioning, ciclosporin A plus methopterin schema is used for preventing graft versus host disease, many complications, low success rate or high reoccurrence rate can be detected. Taken together, arabinosylcytosin, myleran, cyclophosphamide, Me-CCNU and anti-lymphocyte immunoglobulin were used as preconditioning, and ciclosporin A and short-range methopterin plus low-dose mycophenolate were employed to prevent acute graft versus host disease. Hepatic vein occlusion, Ⅱ intestinal acute graft versus host disease and delayed hemorrhage were measured after surgery, but these diseases were mild and could be controlled after treatment of alprostadil, methylprednisolone, alkalization and hydration urine. 52 days after transplantation, chromosome karyotype analysis showed the donor＇s type. 36 months later, the recipient was still alive, and the peripheral hemogram and bone marrow image were normal during reexamination. Thus, we conftrmed that modified Bu-CTX2 preconditioning and allogeneic hematopoietic stem cell transplantation is an effective method for treating a patient with non-remission acute leukemia.