造血干细胞移植治疗儿童白血病的临床研究

Hematopoietic Stem Cells Transplantation for Children with Leukaemia

【目的】评价造血干细胞移植 (HSCT)治疗儿童白血病的疗效及合并症。【方法】非血缘相关脐血移植 (UD UCBT)治疗儿童白血病 5例 (AML 4例 ,HR ALL 1例 ) ;同胞外周血造血干细胞移植 (allo PBSCT)治疗CML及HR ALL各 1例 ;自体外周血造血干细胞移植 (auto PBSCT)治疗AML 2例。UD UCBT中 4例为HLA 5 / 6相合 ,1例为全相合。输入的脐血 (UCB)平均有核细胞数 (NC)为 6 2 9× 10 7/kg ,CFU GM为 0 17× 10 5/kg ,CD34+ 细胞数为 4 6× 10 5/kg。预处理主要以马利兰 (Bu)、环磷酰胺 (CY)、氟达拉宾 (Flu)和马法兰 (Mel)等组成的方案。【结果】 4例可评价的UD UCBT患儿中 3例完全植入 ,1例未植入者自体造血恢复 ,2例allo PBSCT患儿均完全植入。UCBT后外周血中性粒细胞绝对计数 (ANC)≥ 0 5× 10 9/L的中位时间为 +2 1d ,血小板 (PLT)≥ 2 0× 10 9/L的中位时间为 +40d。 2例allo PBSCT患儿外周血ANC≥ 0 5× 10 9/L的中位时间分别为 +10d和 +12d ,PLT≥ 2 0× 10 9/L的中位时间为 +11d和 +14d。 3例植入的UCBT者 2例分别发生Ⅰ度和Ⅲ度aGVHD。 2例allo PBSCT患儿分别发生Ⅱ度和Ⅲ度aGVHD。随访 2 5个月 ,2例auto PBSCT患儿均复发。allo HSCT 7例中 2例复发 ,2例死于移植合并症 ,3例无病存活至今。

To explore the efficacy of hematopoietic stem cells transplantation(HSCT) in children with leukemia 5 children with leukemia were treated by unrelated umbilical cord blood transplantation (UD UCBT)(4 cases with AML, 1 case with HR ALL ); Allogeneic peripheral blood stem cells transplantation (allo PBSCT) for 2 children;Autogeneic peripheral blood stem cells transplantation(auto PBSCT) for 2 children In the UD UCBT patients, 4 donor recipient pairs were HLA 1 locus mismatched and the other one was HLA identical; 2 cases of allo PBSCT were HLA identical In the UD UCBT, patients received a median UCB nucleated cells(NC) of 6 29×10 7/kg,CFU GM of 0 17×10 5/kg, CD34 + cells of 4 6×10 5/kg?The conditioning regimen mainly consisted of busalphan(Bu), cyclosphosphamide(CY),fludarabine(Flu) and melphalan(Mel) 3 cases of UD UCBT were engrafted,1 case died of interstitial pneumonia(IP) on day +66 and 1 case died of sapremia on day +53 The 2 cases of allo PBSCT were all engrafted In UD UCBT,the ANC≥0 5×10 9/L at day +21,PLT≥20×10 9/L at day+40 2 cases of the 3 engrafted patients of UD UCBT developed Ⅰ and Ⅲ aGVHD respectively 2 cases of allo PBSCT developed Ⅱ and Ⅲ aGVHD respectivly Following up for 25 months, 2 cases of auto PBSCT were all relapsed;2 cases of allogeneic hematopoietic stem cells transplantation (allo HSCT) relapsed [Conclustion] HSCT is an effective treatment for children with leukaemia,but how to reduce the rate of relapse remains to be resolved