CD34^+细胞纯化移植治疗高危或复发的急性淋巴细胞性白血病

CD34+cell purification transplantation for the treatment of high-risk or recurrent acute lymphocytic leukemia

为尽可能将采集的自体外周血造血干细胞中肿瘤细胞污染的程度减少到最低、尽可能去除引起移植物抗宿主病(GVHD)的效应细胞 -T细胞 ,以避免父子/母子之间半相合移植后发生严重GVHD可能 ,2例Ph( + )染色体的高危急淋和1例复发急淋被进行自体/异体CD34+ 细胞纯化移植。移植治疗后 :3例病儿全部获得血液系统恢复 ,2例异体移植仅出现轻度的I°-II°GVHD ,STR位点DNA检验以及染色体检查证实均植入成功。病情转归 :1例自体移植于移植后16个月复发 ;1例异体移植于87天感染病毒性多发性神经根炎死亡 ;1例异体移植目前为移植后17个月 ,多次复查骨穿 ,均提示处于缓解状态 ,Ph染色体和bcr/abl基因仍为阴性。结果表明 ,CD34 +细胞移植可以克服异体移植时HLA部分不相配的难点 ,减轻GVHD ;自体CD34+ 细胞移植虽然减少了植入的污染细胞 ,但由于缺乏移植物抗白血病反应 ,移植后仍然有体内白血病细胞复发可能 ,仍然需要维持治疗。

The effect of routine chemotherapy for high risk or recurrent acute lymphocytic leukemia(ALL) with Ph(+) chromosome is not satisfied.These two kinds of patients need stem cell transplantation to obtain better therapeutical effect.In order to reduce contamination of leukemic cells in the collection of auto peripheral blood stem cell before transplantation.One case of recurrent ALL with Ph(+) chromossome was treated with auto CD34+ cell purification transplantation.In order to remove T cell with are the effector cells of graft versus host diseases(GVHD) and to avoid severe GVHD and host versus graft(HVG) reaction for two cases of HLA haploidentical peripheral blood stem cell transplantation(PBSCT) from the mother or father to their son,one case of high risk ALL with Ph(+) chromosome and one case of recurrent ALL were treated with the allo CD34+ cell purification transplantation. As a result,all 3 cases obtained haematopietic recovery.Only slight I° II° GVHD happened in two cases of allo transplantation.The examination of STR DNA site and chromosome both approved success of in plantation.Follow up observation revealed that there was no complications in the case with auto transplantation.But,because this patient did not follow physician′s orders and stopped the maintenance treatment without authorization,relapse occurred 16 months after transplantation.One case of allo transplanta tion died of viral polyradiculitis in +87 days after transplantation.Another case of allo transplantaion is now alive 17 months after transplantation and is still in bone marrow remission.The Ph(+) chromosome and bcr/abl gene keep negative.The STR DNA site check and sex chromosome confirmed the tranferring of type of recipient to that of the donor.Thus,this patient has succeeded in implantation.It is ,then,concluded that allogenic or auto CD34+ cell purification transplantation is one of the effective treatment for high risk or recurrent ALL with Ph(+) chromosome.The allo CD34+ cell purification transplantation could overcome the difficulties of HLA mismatch for allo transplantation and reduce the degree of GVHD.The auto CD34+ cell purification transplantation could also reduce the comtamination of leukemic cells in the collection of auto peripheral blood stem cells,but if has high incidence of relapse after transplantation because of the absence of the reaction of graft versus leukemia.Therefore,the maintenance treatment is still very important after auto CD34+cell purification transplantation.