非亲缘HLA不相合脐血移植治疗再生障碍性贫血

Successful unrelated HLA-mismatched cord blood transplantation in a patient with severe aplastic anemia

目的 :观察HLA位点不相合的非亲缘脐血细胞移植治疗重型再生障碍性贫血 (SAA)的疗效。方法 :采用 5～ 6个HLA位点相合的非亲缘脐血移植治疗SAA患者 1例。输入脐血单个核细胞数为 4.72× 10 7/kg。预处理方案为环磷酰胺 (5 0mg/kg·d-1× 4)、抗淋巴细胞球蛋白 (2 0mg/kg·d-1× 4)和全身照射 (3Gy)。用环胞素、骁悉和泼尼松预防移植物抗宿主病 (GVHD)。结果 :移植后白细胞下降至零 ,持续 12d ,中性粒细胞分别于移植后第 2 4天和第 2 6天恢复至 0 .5× 10 9/L和 1.0× 10 9/L ,血小板分别于移植后第 2 8天和第 82天达到 2 0× 10 9/L和 5 0× 10 9/L ,DNA短串重复序列PCR检测证实为持续稳定的供者造血。随访 12个月未发生急慢性GVHD。结论 :非亲缘脐血移植是治疗重型再障的一种有效的方法。

Objective:To investigate the efficacy of unrelated HLA non-identical cord blood transplantation in severe aplastic anemia (SAA).Method:a patient with SAA was treated by HLA 5/6 antigen matched unrelated cord blood transplantation.The number of mononuclear cells in the cord blood unit from Shandong cord blood bank was 4.72×10 7 /kg.The conditioning regimen consisted of cyclophosphamide (50 mg/kg/d for 4 days), ATG (20 mg/kg/d for 4 days) and TBI (3 Gy). Cyclosporin A, mycophenolate and prednisone were administered for graft versus host disease (GVHD) prophylaxis.Result:White blood cell count dropped to zero after transplantation and lasted for 12 days. Absolute neutrophil count (ANC) reached to the levels of 0.5×10 9/L and 1.0×10 9/L on day +24 and day +26 after transplantation, respectively. Platelet count of 20×10 9/L and 50×10 9/L were reached on day +28 and day +82 after transplantation, respectively.The donor origin stable engraftment was confirmed by PCR analysis of DNA short tandem repeats. No evidence of acute or chronic GVHD was observed within 12 month following-up.Conclusion:Unrelated cord blood transplantation was an effective method for the treatment of SAA.