干细胞移植治疗多次输亲属血的重症再障

Stem Cell Transplantation Treatment in Severe Aplastic Anemia from Mutiple Transfusions of Relatives Blood

目的探讨造血干细胞移植对多次输亲属血的重症再障患者的疗效。 方法 1例曾有 5次输其父亲及兄弟外周血的重症再障患者 ,应用DNA指纹检测法确认HLA配型与患者完全相符的孪生兄弟为同卵双生 ,采用环磷酰胺、全血淋巴结照射和抗胸腺球蛋白 (CY +TBI +ATG)为预处理方案 ,以环胞霉素A和氨甲喋呤 (CsA +MTX)预防移植物抗宿主排异反应 (GVHD)的发生。 结果患者于移植后第 7d及第 10d外周血白细胞计数分别升至 >0 .5× 10 9/L及 >1.0× 10 9/L。患者的外周血血小板计数分别于移植后第 12d及 2 6d升至 >2 0× 10 9/L和 >5 0×10 9/L。骨髓细胞学检查显示粒、红、巨系均增生活跃 ,为增生性骨髓象。 结论以CY +TBI +ATG为预处理方案的造血干细胞移植可预防急性超强GVHD的发生 。

Objective To present the experience of syngeneic stem cell transplantation (bone marrow transplantation following peripheral blood stem cell transplantation) for a transfused patient with severe aplastic anemia. Methods We report our experience of syngeneic stem cell transplantation for a patient with aplastic anemia who had 5 consecutive transfusion from his brother and parents. The patient was conditioned with TBI, clophosphamide (CY) and antithymocyte globulin (ATG). For GVHD prophylaxis the patient received MTX and CsA. The patient had sustained engraftment. Results The time for granulocyte >0.5×10 9/L and >1.0×10 9/L were day 7 and day 10. The time for recovery of a platelet count >20×10 9/L and >50×10 9/L were day 12 and day 26. GVHD did not occur in the patient. Conclusion The combination of CY+TBI+ATG is an effective, well-tolerated conditioning regimen for stem cell transplantation in the transfused aplastic anemia patient, especially in the patient who had been transfused from his relatives.