非清髓性双份脐血移植治疗成人重型再生障碍性贫血8例

Transplantation of non-myeloablative double umbilical cord blood units for severe aplastic anemia in eight adult patients

选择1998-06／2007-12广州市第一人民医院收治的成人重型再生障碍性贫血患者8例进行非清髓性双份供者脐血移植，预处理方案采用减量环磷酰胺＋抗淋巴细胞球蛋白方案，输入的脐血总有核细胞数为5．69×10^7／kg，CD34＋细胞数为4．10×10^5／kg。移植物抗宿主病的预防采用短程甲氨蝶呤联合甲基强的松龙方案。结果中性粒细胞绝对值〉0．5×10^9L^-1的中位时间为移植后17d（7-25d），血小板计数回升〉20×10^9L^-1的中位时间为移植后35d（13～102d）。7例患者DNA指纹图检测显示为供受者嵌合体；2例患者出现Ⅰ～Ⅱ度急性移植物抗宿主病，均得到控制；1例患者出现Ⅱ度慢性移植物抗宿主病，予甲基强的松龙后控制。目前5例患者无病存活10～10^8个月。提示对于成人受者接受非清髓性双份脐血移植在临床上是可行的，非清髓性预处理可保证脐血干细胞的有效植入。

Eight patients with severe aplastic anemia received unrelated cord blood transplantation at the Guangzhou First People＇s Hospital from June 1998 to December 2007. The patients were conditioned with decreased dosage of immunosuppressive agents of cyclophosphamide and antilymphocytic globulin. The median infused donor total nucleated cell were 5.69×10^7/kg of recipient weight, and the CD34＋ cell was 4.10×10^5/kg of recipient weight. Methotrexate and corticoid methylprednisolone were used for prophylaxis of graft versus host disease （GVHD）. The time to reach an absolute neutrophil count of 0.5× 10^9/L ranged from 7 to 25 days （median： 17 days） and the time to reach a platelet count of 20×10^9/L ranged from 13 to 102 days （median： 35 days） after transplantation. DNA finger print map of 7 patients showed donor and recipient chimera. Two patients developed gradeⅠ to Ⅱ acute GVHD, which was controlled. One patients developed grade Ⅱ chronic GVHD, which was controlled by using methylprednisolone. Five patients had lived for 10-108 months, with no diseases. Taken together, unrelated umbilical cord blood transplantation is effective for adult patients. Partial conditioning regiment could ensure engraft of unrelated umbilical cord blood transplantation.