脐血总有核细胞数对脐血移植疗效的影响

Influence of total nucleated cell dose on the efficacy of cord blood transplantation

目的探讨脐血总有核细胞(TNC)剂量对脐血移植疗效的影响。方法 34例血液病患儿接受脐血移植,按照输注平均脐血总TNC数分为3组:TNC>10×107/kg组7例、10×107/kg>TNC≥7×107/kg组9例、TNC<7×107/kg组18例。评估3组患儿造血干细胞植入、排斥、移植疗效。结果 TNC>10×107/kg组7例,均获得长期稳定植入,平均中性粒细胞计数(ANC)>0.5×109/L时间为14.8(12～20)d,PLT>50×109/L时间为52.3(26～86)d,处于无病存活状态。10×107/kg>TNC≥7×107/kg组9例,7例获得植入,平均ANC>0.5×109/L时间为16.4(11～30)d,PLT>50×109/L时间为63.7(34～140)d;4例获得长期稳定植入,无病存活;2例重型β-地中海贫血患者植入后出现排斥,恢复自身造血;1例植入后死亡;1例移植后早期死亡。TNC<7×107/kg组18例,16例获得植入,平均ANC>0.5×109/L时间为19.5(10～29)d,PLT>50×109/L时间为70.1(47～116)d;8例长期稳定植入,无病存活,2例重型β-地中海贫血患者在植入后出现移植排斥,自身造血功能恢复;6例植入后死亡;2例未植入。结论脐血TNC剂量是影响脐血移植中造血干细胞植入时间和嵌合状态的重要因素。增加输注的TNC细胞数可提高脐血移植成功率。

Objective To study the influence of cord blood total nucleated cell（TNC） dose on the efficacy of cord blood transplantation in children.Methods Thirty-four children with hematological disease received cord blood transplantation.They were assigned to 3 groups according to the infused TNC dose：TNC 〉10 × 10^7 /kg（n = 7）,10 × 10^7 /kg TNC≥7 × 10^7 /kg（n = 9） and TNC 〈7 × 10^7 /kg（n = 18）.The rates of graft and rejection of hematopoietic stem cells and the efficacy of transplantation were examined in the three groups.Results All 7 children in the group infused with TNC 〉10 × 10^7 /kg got a long-term stable engraftment.The median time of absolute neutrophil count 〉0.5 × 10^9 /L was 14.8 days（range 12-20 days） and platelets 〉50 × 10^9 /L was 52.3 days（range 26-86 days）.They survived in a disease-free state.Of the 9 children in the group infused with TNC between 10 × 10^7 /kg and 7 × 10^7 /kg,7 got engraftment.The median time of absolute neutrophil count 〉0.5 × 10^9 /L was 16.4 days（range 11-30 days） and platelets 〉50 × 10^9 /L was 63.7 days（range 34-140 days）.Four children got a long-term stable engraftment and survived in a disease-free state.Two children with beta-thalassemia major had secondary rejection after engraftment and autologous hematopoitic recovery.One child died after engraftment and one child died in the early period after transplantation.Of the 18 children in the group infused with TNC 〈7 × 10^7 /kg,16 children got engraftment.The median time of absolute neutrophil count 〉0.5 × 10^9 /L was 19.5 days（range 10-29 days） and platelets 〉50 × 10^9 /L was 70.1 days（range 41116 days）.Eight children had a long-term stable engraftment and survived in a disease-free state.Two children with betathalassemia major had secondary rejection after engraftment and autologous hematopoitic recovery.Six children died after engraftment.Two children had graft failure.Conclusions TNC dose is an important influencing factor for hematopoietic stem cell engraftment in cord blood transplantation.An increased TNC dose may improve the success of cord blood transplantation.