抗CD20单抗在致敏受者异基因造血干细胞移植中的应用

Application of anti-CD20 monoclonal antibody in sensitized receptor who will be treated with umbilical cord blood transplantation

目的:探讨抗CD20单抗(美罗华)在致敏受者造血干细胞移植预处理中应用后的脱敏效果。方法:5例致敏患儿中3例在造血干细胞移植预处理前应用美罗华。对比观察脐血移植后造血重建、供受体DNA短串联重复序列多态性分析嵌合度及有无移植物抗宿主病(GVHD)发生。结果:5例患儿造血干细胞移植后造血完全重建,编号2(未用美罗华)造血重建时间(造血干细胞移植后65 d)明显晚于预处理前使用美罗华患儿(编号3、4、5);其中2例出现血小板植入延迟,编号1(未用美罗华)血小板植入时间较编号4(经美罗华处理患儿)明显延长;5例供受体稳定嵌合;编号1(未用美罗华)出现极重度a GVHD,造血干细胞移植前应用美罗华患儿未出现或仅出现轻至中度a GVHD,编号4出现轻度c GVHD,累及胃肠道,经FK506调整后已明显好转。目前随访中位时间7.5个月,病情稳定。结论:美罗华在致敏受者异基因造血干细胞移植前应用对降低敏感性有一定疗效。

Objective：To evaluate the effect of anti-CD20 monoclonal（RTX）antibody in sensitized recipients of hematopoietic stem cells transplantation. Methods：Three of five children received RTX before allo-geneic hematopoietic stem cells transplantation（HSCT）.Hematopoietic reconstitution,chimerism level of genetic polymorphisms of short tandem repeats between donator and recipients,graft-versus-host disease were observed after implantation. Results：5 cases had hematological recovered after transplantation successfully. Two of them had delayed platelet engraftment. Number 1 case developed severe acute graft-versus-host disease（a GVHD）,but other 3 cases who received RTX before transplantation did not appear or only appeared light to moderate a GVHD. Number 4 case who appeared mild c GVHD,involving the gastrointestinal,has improved significantly after the FK506 adjustment. Now they are all in stable condition. Conclusion：RTX has certain curative effect on allogeneic hematopoietic stem cell transplantation in sensitized receptor.