双重移植成功治疗重型再生障碍性贫血1例并文献复习

Dual transplantation for the treatment of severe aplastic anemia:a case report and literature review

再生障碍性贫血(aplastic anemia,AA)是一种由于物理、化学、生物等因素导致的骨髓衰竭性疾病,临床表现为贫血、出血、感染。重型再生障碍性贫血(severe aplastic anemia,SAA)以及极重型再生障碍性贫血(VSAA)死亡率高,严重威胁患者的生命。目前认为,同胞全相合异基因造血干细胞移植术(MSD-HSCT)是治疗SAA和VSAA最有效的方法[1]。

To explore the feasibility and efficacy of double transplantation in the treatment of severe aplastic anemia(SAA),we analyzed a patient with SAA who got matched sibling donor allogeneic hematopoietic stem cell transplantation in June 2017 in our department.Since the number of CD34^+ cells in the bone marrow and peripheral blood was not enough for the stem cell implantation,he then infused of an unrelated umbilical cord.The patient received granulocyte implantation at ninth day after the double transplantation and obtained the platelet implantation at seventeenth day after transplantation.So he obtained the hematopoietic reconstitution successfully.At the first month after transplantation,the bone marrow was checked for primary disease relief.Bone marrow donor cells were chimeric into 100% sibling donor sources.After 6 months,bone marrow donor cell chimerism was transformed into 100% umbilical cord blood source.The patient survived without disease until now.This patient was treated successfully infusing matched sibling donor low dose CD34^+ cells combined with unrelated umbilical cord blood transplantation.He was alive without acute and chronic graft-versus-host disease.The new double transplantation can be used to treat SAA to improve the effect of transplantation.