儿童高危急性淋巴细胞白血病脐血干细胞移植失败后白血病长期缓解1例暨文献复习

Long-term remission of leukemia after failure of cord blood stem cell transplantation for high-risk childhood acute lymphoblastic leukemia: a report of one case and literature review

目的分析儿童高危急性淋巴细胞白血病脐血移植失败后白血病长期缓解的原因。方法收集2013年9月在中山大学附属第三医院血液内科接受脐血干细胞移植的1例高危急性淋巴细胞白血病患儿的临床资料。分析患儿术后治疗过程及预后,并结合文献资料分析患者移植失败但白血病治疗获得良好效果的可能原因。结果患儿首次脐血干细胞移植后造血恢复不良,2013年11月行脐血输注,后因为经济原因未针对原发病进一步治疗,然而该患者脐血移植术后15个月造血功能恢复,至2015年9月,脐血移植后2年无病生存。结论脐血移植或输注可能具有修复造血及免疫系统的功能,且无需通过成功植入发挥作用。儿童高危白血病进行脐血移植植入失败并不意味白血病治疗失败,患儿有可能获得长期无病生存。

Objective To analyze the reasons for long-term remission of leukemia after failure of cord blood stem cell transplantation for high-risk childhood acute lymphoblastic leukemia.Methods Clinical data of 1 child with high-risk acute lymphoblastic leukemia undergoing cord blood stem cell transplantation in the Department of Hematology of the Third Affiliated Hospital of Sun Yat-sen University in September 201 3 were collected.The treatment course and prognosis of the child were analyzed.In combination with literatures,the possible reasons for the good treatment effect on leukemia after transplantation failure were analyzed.Results The hematopoietic recovery of the child after the first cord blood stem cell transplantation was poor.The child underwent cord blood infusion in November 201 3 and did not undergo further treatment for the primary disease due to economic reasons. However, the hematopoietic function recovered 1 5 months after cord blood transplantation.Till September 201 5,2-year disease free survival after cord blood transplantation was obtained.Conclusions Cord blood transplantation or infusion may repair the function of hematopoietic system and immune system,and may take effect with no need of successful transplantation.The failure of cord blood transplantation for childhood high-risk leukemia does not mean treatment failure.Children patients may obtain long-term disease free survival.