同胞间脐血移植治疗小儿急性淋巴细胞性白血病的时机选择与随访(附3例分析)

Clinical choice and follow-up of sibling cord blood transplantation in 3 children with acute lymphoblastic leukemia

目的:同胞脐血具有组织相容性高,易获得HLA配型一致而不易被排斥的特点,本文报道同胞间脐血移植治疗3例小儿急性淋巴细胞性白血病的疗效并进行随访。方法:对3例急性淋巴细胞性白血病(2例高白细胞性高危CR1,1例标危并发中枢神经系统白血病CR2),进行了同胞间脐血移植,HLA高分辨2例全相合,1例5个位点相合。预处理选用白消安/环磷酰胺为主方案。于0d回输脐血,MNC数量为2.65×107/kg,2.23×107/kg,2.18×107/kg;CD34+细胞数量为1.92×107/kg,1.39×105/kg。预防移植物抗宿主病采用环孢霉素A、甲基泼尼松龙和甲氨蝶呤的方案。结果:中性粒细胞绝对值(ANC)≥0.5×109/L的天数分别是+13d、+24d、+20d,PLT≥20×109/L的时间为+19d、+46d、+21d,移植证据均为供者型。3例出现Ⅰ-Ⅱ度GVHD,均控制。随访中发生Ⅱ度慢性GVHD 1例,现长期存活2例,生活良好。结论:同胞间脐血移植是儿童高危白血病有效的治疗手段,急、慢性GVHD发生率较低,存在移植物抗白血病作用,更为安全可靠。

Objective：Sibling cord blood has the clear benefits of HLA match compatiblity and less delayed engraftment.The aim of this study was to investigate the efficacy of sibling cord blood transplantation（CBT） in 3 children with acute lymphoblastic leukemia and follow up.Methods： Three children with acute lymphocyte leukemia,including two high risk（high WBC type）patients in the first complete remission and one standard risk patient with central nervous system leukemia in the second complete remission,received a sibling cord blood transplantation.The cord blood grafts were HLA-matched（n=2）or HLA-mismatched at 1（n=1）.Busulfan/cyclophosphamide was involved in the myeloablative pretreatment regimen.The infused donor nucleated cell was 2.65×107/kg,2.23×107/kg,2.18×107/kg of recipient weight respectively,and the CD34＋ cell was 1.92×107/kg,1.39×105/kg of recipient weight respectively,one case was not detected.Cyclosporin,corticoid,mycophenolate mofetil and methotrexate were used for prophylaxis of acute graft versus host disease（GVHD）.Results： The time to reach an absolute neutrophil count of 0.5×109/L were engrafted on 13d,24d,20 days respectively,to reach a platelet count of 20×109/L were on 19d,46d,21 days respectively after transplantation.The donors hematopoietic stem cells were shown in these recipient.Three patients developed grade I toⅡacute GVHD but responded to therapy.Chronic grade Ⅱ GVHD was found and two patients survived and did not relapse during follow up.Conclusion： Sibling cord blood transplantation is established options to treat children who have high-risk leukemia or have relapsed after standard therapy,it is an effective and more safe way in childhood.The incidence of acute or chronic GVHD is lower in CBT recipients,graft versus leukemia were existed.