同种异基因骨髓移植治疗小儿难治性白血病

Allogeneic Bone Marrow Transplantation for Childhood Refractory Leukemia

本文介绍我科近来成功应用同种异体骨髓移植（Ａｌｏ－ＢＭＴ）治疗１例小儿复发性白血病的方法、结果和经验体会。资料与方法：１）病例：男性病儿，７岁，急性粒单细胞白血病（Ｍ４ａ）复发，经再次诱导治疗获缓解（ＣＲ２），巩固和强化治疗３疗程后行ＡｌｏＢＭＴ；２）供体：同胞弟弟，４岁，组织配型结果ＨＬＡ－Ａ、Ｂ和ＤＲ位点全相合，但红细胞血型不合；３）移植步骤：①预处理，由全身放疗（ＴＢＩ），８００ｃＧＹ（肺部屏蔽６００ｃＧＹ）。②化疗：ＣＴＸ６０ｍｇ／ｋｇ×２ｄ；ＶＰ１６６００ｍｇ／ｍ２×１ｄ；Ａｒａ－Ｃ１０００ｍｇ／ｍ２×１ｄ。③骨髓动员与采集：应用重组人粒系集落刺激因子（ｒＧ－ＣＳＦ）５μｇ／ｋｇ·ｄ－１，皮下注射５ｄ作骨髓造血干细胞动员后，第５ｄ供体全麻下，于双侧髂脊多位点抽取骨髓液３５０ｍＬ，供体于术中输血４００ｍＬ，术后恢复良好。④骨髓液特殊处理和输注：６％羟乙基淀粉沉淀骨髓液中与受体血型不合之Ａ型红细胞后，静脉快速滴注。输入有核细胞为１５×１０９／ｋｇ，含ＣＤ３４＋细胞３４５×１０６／ｋｇ。⑤促进骨髓增生：移植第一天起，ｒＧ－ＣＳＦ：１０μｇ／ｋｇ·ｄ－１，直至外周白细胞计数恢复；４）副反应防治：①病?

Objective:The clinical results and experience of allo-BMT for one case of childhood refractory leukemia were reported.Methods:The boy was 7 years old,with relapsed acute myeloid leukemia (M4a),and got second complete remission.The results of HLA-a,B and DR typing of the 4 years old male sibling donor was identical to the patient.The conditioning regimen was combined with high dose chemotherpy CTX,Ara-C,VP16) and total body irradiation (TBI).1 5×10 8 of nucleated cells/kg and 3 45×10 6 of CD34+cells/kg collected from bone marrow of donor was infused.Prophyolaxis for GVHD consisted of MTX and CSA.Results:The peripheral blood white cell count achieved >0 5×10 9/L by day 16 after BMT.Incidence of I GVHD appeared after BMT.The initial blood type of the patient(O) turned to the type of the donor (A) and marrow smear examination showed normal after BMT.The 4 years old donor devoted marrow didn't appeared any unhealthy manifestations. Conclosions: Allo-BMT is useful to refractory leukemia.The results of allo-BMT for this patient and the prophylaxis for side effects of the BMT were very successful.