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对1例Ph+染色体的急淋患儿进行母子间HLA半相合的异体外周血造血干细胞移植 ,为避免由于HLA不相合所产生的由T细胞介导的严重移植物抗宿主病(GVHD) ,采用了CD34+细胞正性分离去除淋巴细胞 ;同时为避免由于T细胞过度去除而引起宿主抗移植物反应(HVG)导致植入失败 ,在移植次日又加入部分T细胞 ,使病儿接受CD34 +细胞6×106/kg 和CD3 +细胞1.05×107/kg。结果 :随访1年来 ,红系、粒系和巨核系均恢复正常 ,临床上仅出现一过性的IIOaGVHD以及轻微的局限于口唇粘膜的cGVHD。STR位点DNA检验以及染色体检查 :移植后 +180天受体已从供体型嵌合体转为完全供体型 ,病儿获得植入成功。结果表明 ,常规剂量的CD34 +细胞移植加以适量CD3 +T细胞 ,可克服HLA部分不相配的难点 ,减轻GVHD ,同时也可避免由于过度的T细胞去除而出现的HVG。
In order to prevent T cell mediated severe graft-versus-host disease (GVHD) due to HLA mismatch, we performed HLA-haploidentical allogeneic peripheral blood stem cell transplantation in one child with Ph + chromosome. Positive CD34 + cells to remove lymphocytes; the same time to avoid over-removal of T cells caused by host anti-graft reaction (HVG) lead to failure of implantation, the day after the transplant and part of the T cells added to the sick children receive CD34 + cells 6 × 106 / kg and CD3 + cells 1.05 × 107 / kg. Results: All the erythroid, granulocytic and megakaryocytic lines returned to normal after one year of follow-up. Only transient IIOaGVHD and mild cGVHD confined to the oral mucosa were observed clinically. STR site DNA test and chromosomal examination: 180 days after transplantation, the donor has changed from a donor-type chimera to a complete donor, and the sick child receives a successful implantation. The results showed that the conventional dose of CD34 + cell transplantation with appropriate amount of CD3 + T cells can overcome the difficult part of the HLA mismatch, reduce GVHD, but also avoid HVG due to excessive T cell depletion.