摘要
Objective To explore an effective measurement for severe aplastic anemia (SAA) Methods A 27 year old woman was admitted to our hospital in February 10, 1998, complaining of dizziness for 15 days and with a fever for 4 days On physical examination, the patient had a fever (38 5℃) without petechia on skin, and without lymphadenopathy and hepatosplenomegaly The laboratory findings were as follows: white blood cell count 1 0×10 9/L, hemoglobin 42?g/L, and reticulocyte 0 01% Bone marrow slides showed marked hypocellularity, cellullarity being about 4%, no megakarocyte founded A diagnosis of SAA was made Syngeneic peripheral blood stem cell transplantation (PBSCT) was performed 26 days after the diagnosis The donor was the patient's twin sister After receiving informed consent, we gave the donor granulocyte colony stimulating factor (G CSF: Kirin, Japan) at a dose of 6?μg/kg subcutaneously daily for 5 days, 3?μg/kg for another day On the 5th day from the beginning of the G CSF administration, peripheral mononuclear cell (MNC) were collected (for the first two collections, Fenwal CS 3000 Plus was used, MCS3p was used for the last one) For each leukapheresis, 8 liters of blood was processed at flow rates60?ml/min The apheresis product of cell suspension was mixed with the same volume of MEM containing 20% dimethylsulphoxide The cell suspension was transferred into freezing bags and frozen to -80℃ with a computer controlled cryopreservation device The frozen cells were transferred into the liquid phase of nitrogen and stored at -196℃ For the conditioning of the patient, 50?mg/kg per day cyclophosphamide was given, i v, for 3 consecutive days Results After 3 days of collection, the total leukapheresis product contained 10 87×10 8/kg recipient body weight MNC, 48 88×10 6/kg CD34 + cells, 50 8×10 4/kg CFU GM cells, 48 hours after conditioning for recipient, products were transfused on day 0, 1, 2 The total infused MNC was 7 93×10 8/kg, 39 48×10 6/kg CD34 + cells, 40 6×10 4/kg CFU GM cells The patient achieved rapid hematopoietic reconstitution The recovery of neutrophils (>1 0×10 9/L) and platelets (>50×10 9/L) in this case after PBSCT was the 12th and 19th day respectively A bone marrow examination was performed on the 15th day after the first peripheral blood stem cell infusion, showing normal cellularity and normal hematopoiesis with many megakarocytes On the 46th day, peripheral blood cell count recovered to normality The patient has been in an excellent clinical performance status over four months following PBSCT Conclusion PBSCT may be a safe and effective alternation to bone marrow transplantation in the treatment of SAA The long term effect will be further observed
Objective To explore an effective measurement for severe aplastic anemia (SAA) Methods A 27 year old woman was admitted to our hospital in February 10, 1998, complaining of dizziness for 15 days and with a fever for 4 days On physical examination, the patient had a fever (38 5℃) without petechia on skin, and without lymphadenopathy and hepatosplenomegaly The laboratory findings were as follows: white blood cell count 1 0×10 9/L, hemoglobin 42?g/L, and reticulocyte 0 01% Bone marrow slides showed marked hypocellularity, cellullarity being about 4%, no megakarocyte founded A diagnosis of SAA was made Syngeneic peripheral blood stem cell transplantation (PBSCT) was performed 26 days after the diagnosis The donor was the patient's twin sister After receiving informed consent, we gave the donor granulocyte colony stimulating factor (G CSF: Kirin, Japan) at a dose of 6?μg/kg subcutaneously daily for 5 days, 3?μg/kg for another day On the 5th day from the beginning of the G CSF administration, peripheral mononuclear cell (MNC) were collected (for the first two collections, Fenwal CS 3000 Plus was used, MCS3p was used for the last one) For each leukapheresis, 8 liters of blood was processed at flow rates60?ml/min The apheresis product of cell suspension was mixed with the same volume of MEM containing 20% dimethylsulphoxide The cell suspension was transferred into freezing bags and frozen to -80℃ with a computer controlled cryopreservation device The frozen cells were transferred into the liquid phase of nitrogen and stored at -196℃ For the conditioning of the patient, 50?mg/kg per day cyclophosphamide was given, i v, for 3 consecutive days Results After 3 days of collection, the total leukapheresis product contained 10 87×10 8/kg recipient body weight MNC, 48 88×10 6/kg CD34 + cells, 50 8×10 4/kg CFU GM cells, 48 hours after conditioning for recipient, products were transfused on day 0, 1, 2 The total infused MNC was 7 93×10 8/kg, 39 48×10 6/kg CD34 + cells, 40 6×10 4/kg CFU GM cells The patient achieved rapid hematopoietic reconstitution The recovery of neutrophils (>1 0×10 9/L) and platelets (>50×10 9/L) in this case after PBSCT was the 12th and 19th day respectively A bone marrow examination was performed on the 15th day after the first peripheral blood stem cell infusion, showing normal cellularity and normal hematopoiesis with many megakarocytes On the 46th day, peripheral blood cell count recovered to normality The patient has been in an excellent clinical performance status over four months following PBSCT Conclusion PBSCT may be a safe and effective alternation to bone marrow transplantation in the treatment of SAA The long term effect will be further observed
