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目的探讨异基因外周血造血干细胞移植治疗极重度骨髓型急性放射病的效果,积累临床经验。方法1例患者意外受~(60)Co照射,受照射剂量为9～15 Gy,诊断为极重度骨髓型急性放射病,在受照射后第4天患者开始接受预处理,3 d后进行了HLA全相合的异基因外周造血干细胞移植。移植后采用环孢素A和霉酚酸酯预防移植物抗宿主病(GVHD)。结果造血功能于移植后第9天开始恢复,第11天WBC升至14.74×10~9/L,随后降至正常范围,血小板升至50×10~9/L,Hb在80 g/L以上。经短串联重复序列聚合酶链反应及血型动态检测,证实供者细胞稳定植入,原有染色体畸变和微核均消失,血型于移植后第27天完全转变为供者型。患者未发生GVHD,但放射性损伤持续加重,并发多重感染,于移植后第68天(受照射后第75天)死于多脏器功能衰竭。结论极重度骨髓型急性放射病可以通过异基因造血干细胞移植恢复造血功能,为患者存活创造机会,但仅有造血功能恢复,而未能解决好放射线对全身组织的损伤及免疫功能重建,患者仍难长期存活。
Objective To investigate the effect of allogeneic peripheral blood stem cell transplantation in the treatment of very severe acute myeloid leukemia and to accumulate clinical experience. Methods One patient was accidentally exposed to 60Co and irradiated to a dose of 9-15 Gy. The patient was diagnosed with extremely severe acute myeloid leukemia. The patient received pretreatment on the 4th day after irradiation, and after 3 days, HLA Fully compatible allogeneic peripheral blood stem cell transplantation. Ciclosporin A and mycophenolate mofetil are used to prevent graft versus host disease (GVHD) after transplantation. Results The hematopoietic function began to recover on the 9th day after transplantation. On the 11th day, the WBC increased to 14.74 × 10 ~ 9 / L, then decreased to the normal range. The platelet increased to 50 × 10 ~ 9 / L and Hb was over 80 g / L . The short tandem repeat polymerase chain reaction and blood group dynamic test confirmed that the donor cells were stably implanted, the original chromosomal aberrations and micronuclei disappeared, and blood type completely changed to donor type on the 27th day after transplantation. GVHD did not occur in patients, but radiation injury continued to worsen with multiple infections and died of multiple organ failure on the 68th day after transplantation (75 days after irradiation). Conclusion Severe acute myeloid leukemia can restore hematopoietic function through allogeneic hematopoietic stem cell transplantation and create opportunities for survival of patients. However, only hematopoietic function is recovered, but radiation damage to whole tissues and immune reconstruction are still not possible Long-term survival.