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目的探讨母亲供髓异基因造血干细胞移植(Allo-HSCT)治疗恶性复发非霍奇金淋巴瘤的疗效和供体造血干细胞来源问题。方法2004年1月,第一军医大学南方医院儿科与海军总医院儿科给1例8岁男性淋巴母细胞淋巴瘤(LBL)患儿移植了母亲来源的HLA不全相合、ABO血型不合的骨髓造血干细胞。预处理选用阿糖胞苷、足叶乙苷、环磷酰胺和全身照射。预防移植物抗宿主病(GVHD)采用兔抗人T-淋巴细胞免疫球蛋白、环孢菌素A、甲氨蝶呤和CD25单克隆抗体。移植有核细胞数8.92×108/kg,单个核细胞数为1.89×108/kg,CD34细胞数为1.37×106/kg,CD3细胞数为32.9×107/kg。结果粒细胞绝对数>0.5×109/L的天数是移植后15d(+15d),血小板>30×109/L的天数是+20d,+27d采用荧光原位杂交性染色体检测显示99%为供者型。+37d受者血型由O型转变为供者血型B型。患儿于+19d出现Ⅰ度急性GVHD,给予激素冲击后,口服小剂量维持治疗,渐消退,随访1年余,未发生慢性GVHD。结论母亲来源的骨髓造血干细胞移植对LBL有根治性治疗作用,而且在一定程度上解决造血干细胞来源问题。
Objective To investigate the efficacy of mother-donor allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in the treatment of malignant recurrent non-Hodgkin’s lymphoma and the origin of donor hematopoietic stem cells. Methods In January 2004, pediatric patients with pediatric lymphoblastic lymphoma (LBL), 8 years old, from Nanfang Hospital, First Military Medical University, underwent pediatric HLA-incompatibility and ABO-incompatible bone marrow hematopoietic stem cells . Pretreatment selection of cytarabine, etoposide, cyclophosphamide and systemic irradiation. Prevention of graft versus host disease (GVHD) uses rabbit anti-human T-lymphocyte immunoglobulin, cyclosporine A, methotrexate and CD25 monoclonal antibodies. The number of transplanted nucleated cells was 8.92 × 108 / kg, the number of mononuclear cells was 1.89 × 108 / kg, the number of CD34 cells was 1.37 × 106 / kg and the number of CD3 cells was 32.9 × 107 / kg. Results The number of days when the absolute number of granulocytes> 0.5 × 109 / L was 15 days after transplantation (+ 15 days), the number of days with platelets> 30 × 109 / L was + 20 days, and 99% was detected by fluorescence in situ hybridization Type. + 37d Recipient blood group changed from O type to donor type B blood type. Children with grade Ⅰ acute GVHD on + 19d, given hormone shock, oral maintenance treatment, gradually subsided, follow-up more than 1 year, no chronic GVHD. Conclusion The mother-derived bone marrow hematopoietic stem cell transplantation has a radical therapeutic effect on LBL, and to some extent, solves the problem of the origin of hematopoietic stem cells.