非血缘脐血移植失败行二次单倍型造血干细胞移植成功治疗骨髓增生异常综合征1例并文献复习

Successful treatment of 1 myelodysplastic syndrome by secondary haploidentical stem cell transplantation after the failure of unrelated umbilical cord blood transplantation

目的:探讨非血缘脐血移植治疗骨髓增生异常综合征失败后立即行半相合型造血干细胞二次移植作为解救方法的可能性和安全性。方法:1例骨髓增生异常综合征-难治性血细胞减少伴多系增生异常(MDS-RCMD)3年余患者,进行非血缘HLA不全相合双份脐血造血干细胞移植,移植后+30dSTR-PCR检测移植物未植入,立即予患者进行半相合造血干细胞干细胞移植以挽救患者生命。供者为患者母亲,采用"骨髓加外周血联合造血干细胞移植",预处理方案采用"抗胸腺细胞球蛋白+福达拉滨"。结果:二次移植物成功植入,形成完全供者来源的造血与免疫功能,二次移植后12dANC>0.5×109/L,+15dPLT>20×109/L,无急慢性GVHD等并发症的发生,随访19月余,患者获得长期无病生存。结论:非血缘脐血移植失败后,50d内行半相合型造血干细胞移植治疗骨髓增生异常综合征是安全、有效的挽救治疗措施。

Objective：To investigate the possibility and safety of secondary haploidentical stem cell transplantation in a short time because of the failure in the first HLA-mismatched unrelated double umbilical cord blood transplantation for myelodysplastic syndrome. Method： 1 myelodysplastic syndrome refractory cytopenia of mukilineage dysplasia for 3 years, the transplantation of unrelated double umbilical cord blood was performed for the first time, there was no engraftment at 〉30 days after the first transplantation by STR PCR detecting, secondary haploidentical stem cell transplantation was administered to save patient＇s life. The donor was patient＇s mother, bone marrow and the peripheral blood stem cells transplantation was adopted. The preconditioning regiment was ATG ＋ FLU. Resalt： Successful engraftment was acquired after the second transplantation, ANC 〉0. 5 × 10^9/L at ＋ 12 days and PLT 〉20 × 10^9/L at ＋ 19 days after the secondary transplantation, hematopoietie and immunological function were successfully reconstitution from the donor, no acute or chronic GVHD and other complications oc curenced. After followed up more than 19 months, the patient acquired disease-free survival of long-term. Conclusion：Secondary haploidentical stem cell transplantation was an effective and security therapy in 50 days after the first unsuccessful unrelated umbilical cord blood transplantation for myelodysplastic syndrome.