原发耐药T淋巴母细胞淋巴瘤白血病异基因造血干细胞移植并发乳糜胸1例并文献复习

Chylothorax after allogeneic hematopoietic stem cell transplantation in primary drug resistance T cell lymphoblast leukemia:a case report and literature review

目的:总结造血干细胞移植过程中发生乳糜胸的治疗经验,并为异基因造血干细胞移植物中干细胞和过客淋巴细胞对植入的影响提供了现实依据。方法:报告1例原发耐药T淋巴母细胞淋巴瘤白血病患者行同胞全和异基因造血干细胞移植过程中发生损伤性大量乳糜胸的临床及治疗经过。结果:通过造血干细胞移植患者原发病获得了持续缓解,同时通过抽胸水、移植后早期胸腔镜下结扎胸导管等治疗手段,成功治疗了乳糜胸,并为移植早期发生乳糜胸淋巴液丢失对造血干细胞移植的影响积累了经验。结论:造血干细胞移植为部分原发耐药的T母细胞淋巴瘤患者提供了治愈机会;胸导管损伤供者淋巴细胞的丢失不影响移植物的植活;移植后早期微创手术的干预降低了大量乳糜胸的死亡率。

Objective：Summarize the treatment experience of chylothorax occurred in the process of hematopoietic stem cell transplantation,and to provide the factual basis for the influence of stem cells and traveler lymphocytes in allogeneic hematopoietic stem cell transplants.Method：Reviewing the clinical symptoms and therapy procedure of chyothorax occurred after sibling hematopoietic stem cell transplantation in a patient with primary resistance T cell lymphoblast leukemia.Result：The patient attained a sustained remission by hematopoietic stem cell transplantation,and the therapy-related chylothorax was successfully treated by local suction,and early thoracic duct ligation by VATS（video-assisted thoracoscopic surgery）,which is benefit for recognition the effect of lymph lost of chylothorax on hematopoietic stem cell transplantation.Conclusion：Hematopoietic stem cell transplantation provides opportunity to cure for part of the primary resistance T cell lymphoblast leukemia patients;the loss of donar＇s lymphocyte by damaged thoratic duct did not influence the grafts＇ survival.Invasive surgery reduces the mortality of chylothorax in the early stage of transplantation.