父供女HLA半相合造血干细胞移植后供者DC-CIK细胞输注治疗儿童难治复发性急性髓细胞白血病1例并文献复习

Treatment of refractory and relapsing childhood acute myelocytic leukemia with HLA partially mismatched stem cell transplantation with father as donor and donor DC-CIK cells infusions:a case report and literature review

目的探索儿童难治复发性急性髓细胞白血病的治疗方法。方法对1例难治复发性急性髓细胞白血病M1患儿,行父供女人类白细胞抗原(HLA)半相合造血干细胞移植,移植前骨髓原始粒细胞16%,原幼单核细胞44.5%,未缓解。供者为其父亲,HLA半相合;预处理方案采用洛莫司汀+阿糖胞苷+白消安+环磷酰胺+抗胸腺细胞球蛋白(ATG);用骁悉、环孢素、甲氨蝶呤及ATG预防移植物抗宿主病(GVHD)。结果患儿移植后14 d造血功能重建,移植后21 d复查骨髓完全缓解,骨髓染色体检查完全转为供者型,移植后23 d开始每周输注供者树突状细胞-细胞因子诱导为杀伤细胞(DC-CIK)共5次,细胞数按梯度递增。患者定期监测血常规各项指标均基本正常,移植后130 d复查骨髓示完全缓解,现继续随访中。结论供者DC-CIK细胞过继性治疗降低了异基因造血干细胞移植后白血病的复发概率,是有效且值得探索的新手段。

Objective To explore the effective method to treatment refractory and relapsing childhood acute myelocytic leukemia.Methods A childhood patient with refractory and relapsing acute myelocytic leukemia received HLA partially mismatched haemopoietic stem cell transplantation from her farther as a donor.There were 16% myeloblast and 44% primitive and naive monocytes in marrow before transplantation which confirmed non-remission.The condition regimen included CCNU,Ara-C,busulfan,cyclophosphamide and antihuman thymocyte globulin.Cytosporin A,methotrexate,mycophemolate mofetil and antithymus globulin were used to prevent graft versus host disease.Results The patient obtained haematopoietic reconstitution on day 14.Bone marrow aspiration was performed and confirmed complete remission and the examinations of sexual chromosome indicated full donor-type on day 21.Five times donlymphocte infusions with quantity of cells increasing by degrees were respectively performed once a week from day 23.regularly monitoring the blood routine shows all indexes of the patient are normal.Bone marrow aspiration was performed and confirmed complete remission on day 130.Conclusion Adoptive immunotherapy with DC-CIK cells which is a new effective method to reduce probability of palindromia of leukemia followed allogenic transplantation.