单倍体造血干细胞移植治疗急性淋巴细胞白血病植入失败的二次移植策略

Secondary transplantation strategy for graft failure of haploidentical hematopoietic stem cell transplantation for acute lymphocytic leukemia

目的探讨急性T淋巴细胞白血病患者初次单倍体造血干细胞移植后植入失败并发生致命性并发症的二次移植策略。方法 1例男性患者诊断为急性T淋巴细胞白血病,2015年11月接受供者为其胞妹的首次单倍体造血干细胞移植后植入失败,并发生大肠杆菌败血症、血清病、肝静脉闭塞症和多器官功能衰竭。首次移植后32 d行供者为其父亲的挽救性二次单倍体造血干细胞移植,二次移植前未进行预处理化学药物治疗(化疗),采用移植后环磷酰胺(PTCy)方案为基础的移植物抗宿主病(GVHD)预防方案。结果造血干细胞移植术后12 d白细胞植入,术后67 d血小板植入。血清病、败血症及肝静脉闭塞症治愈,器官功能改善。但移植后第18个月,即2017年6月,患者死于白血病复发。结论植入失败患者二次移植前不进行预处理化疗,采用PTCy预防GVHD有望获得成功植入。

Objective To explore the secondary transplantation strategy for graft failure of the primary haploidentical hematopoietic stem cell transplantation(haplo-SCT)associated with fatal complications in a patient with acute T-cell lymphocytic leukemia.Methods One male patient was diagnosed with acute T-cell lymphocytic leukemia.In November 2015,he received haplo-SCT from his sister as the donor.But graft failure was developed and complicated by Escherichia coli sepsis,serum disease,hepatic venous occlusion and multiple organ failure.At 32nd d after the first transplantation,secondary haplo-SCT from his father as the donor was performed.Prior to secondary transplantation,chemotherapy pretreatment was not conducted.Post-transplantation cyclophosphamide(PTCy)-based prevention measure against the graft-versus-host disease(GVHD)was adopted after transplantation.Results White blood cells were implanted on the 12nd d and platelet implantation was performed on the 67th d after haplo-SCT.Serum disease,septicemia and hepatic venous occlusion were cured and organ function was improved.However,the patient died from the recurrence of leukemia at 18th months after transplantation(June 2017).Conclusions Prior to secondary haplo-SCT,PTCy prevention measures against the GVHD rather than pretreated chemotherapy probably contributes to the success of transplantation.