2例异基因造血干细胞移植后的植入状态监测及近期胸腺功能重建

Analysis of chimerism detection and recent thymic output in 2 patients after allo hematopoietic stem cell transplantation

目的监测异基因造血干细胞移植后的植入状态,评价移植后的近期胸腺功能重建。方法对1例接受人类白细胞抗原(human leukocyte antigen,HLA)半相合亲缘供者与1例HLA全相合非亲缘供者异基因造血干细胞移植(allo-HSCT)治疗的白血病患者,收集供者和受者术前、受者移植后1个多月、受者移植后4个多月的EDTA抗凝静脉血,同时采集10例正常健康志愿者的EDTA抗凝静脉血作为正常对照。采用STR-PCR技术检测20个常染色体STR基因座及1个性别基因座的基因型。采用实时荧光定量PCR方法检测受者不同时期和10例正常健康志愿者的T细胞受体DNA重排删除环(TREC)水平。结果 2例造血干细胞移植病例监测在移植后1个多月及4个多月均完全表现为供者源型。造血干细胞移植后1个多月及4个多月,半相合供者的白细胞及血小板恢复晚于HLA全相合供者。2例病人移植前TREC相对定量略低于年龄相近的正常对照组,移植后1个多月及4个多月TREC水平明显升高,其中HLA全相合移植病人TREC相对定量高于HLA半相合移植病人。结论移植后1个多月及4个多月供者造血干细胞在受者体内完全植活。全相合造血干细胞移植后造血及免疫重建快于半相合造血干细胞移植。

Objective To detect hematopoietic chimerism and to analyze the significance of recent thymic output in 2recipients after allogeneic hematopoietic stem cell transplantation（allo-HSCT）.Methods Multiplex polymerase chain reaction（PCR）method was used to detect 21 STR loci labeling with fluorescence in both donor and recipient peripheral blood samples at more than one month and more than four month after allo-HSCT.Meanwhile,TREC was detected using real-time quantitative PCR for patients at more than one month and more than four month after allo-HSCT.Results Donor alleles appeared in both HLA half-matched（5/10）and matched（10/10）recipients at more than one month and more than four month after allo-HSCT.STR-PCR may be an efficient way to detect donor-recipient chimerism after transplantation.Both leukocyte and blood platelet counts recovers faster in matched（10/10）recipient and half-matched recipient after allo-HSCT.Compared with HLA halfmatched（5/10）recipient,HLA-matched（10/10）recipient had higher TREC levels after transplantation,and the TREC levels had recovered and reached higher to normal levels in recipient at more than one month,then increased slowly at more than four month.Conclusion Our results demonstrate that the engraftment is succeeded at more than one month and more than four months after allo-HSCT.Compared with HLA half-matched（5/10）recipient,HLA-matched（10/10）recipient has faster recovery in immune reconstution after transplantation.