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目的 研究脐血移植 (CBT)治疗成人恶性血液病的可行性 ,观察长期造血重建和移植相关并发症的发生。方法 1例 18岁体重 75kg的慢性髓系白血病慢性期 (CML CP)患者在用改良的马利兰、环磷酰胺 (Bu CTX)方案预处理后给予HLA相合同胞CBT。输入有核细胞数 1.73× 10 7 kg ,CD3 4 +细胞为 2 .7× 10 5 kg。移植物抗宿主病 (GVHD)预防方案选用环孢菌素A(CsA)加甲泼尼龙。结果 移植后第 18天中性粒细胞计数 >0 .5× 10 9 L ,移植后 36天血小板计数 >5 0× 10 9 L。CBT后共给予 7次血小板输注。移植后 80天DNA位点检测示已全部转为供者型。移植后 90天后出现严重黄疸 ,诊断为肝脏急性GVHD合并巨细胞病毒感染 ,通过加用免疫抑制剂和抗病毒药物治疗 ,同时辅以血浆交换和人工肝体外胆红素吸附 ,并发症得到控制。随访 2 4个月 ,患者一般情况良好 ,肝功能基本正常 ,骨髓细胞Ph染色体和bcr abl基因持续阴性。结论 本例为国内首例应用异基因CBT成功治疗成人白血病 ,表明异基因CBT应用于成人血液病的治疗是可行的。
Objective To study the feasibility of umbilical cord blood transplantation (CBT) in the treatment of hematological malignancies in adults and to observe the long-term hematopoietic reconstitution and transplantation-related complications. Methods A 18-year-old, 75-kg, 75-kg, chronic phase myeloid leukemia patient (CML CP) patient was given HLA-identical sibling CBT after pretreatment with a modified maleic and cyclophosphamide (BuCTX) regimen. The number of nucleated cells was 1.73 × 10 7 kg, and CD3 4 + cells were 2. 7 × 10 5 kg. Graft-versus-host disease (GVHD) prevention program selected cyclosporin A (CsA) plus methylprednisolone. Results The neutrophil count was >0.5×10 9 L on the 18th day after transplantation, and the platelet count was >50×10 9 L on the 36th day after transplantation. Seven platelet transfusions were given after CBT. 80 days post-transplant DNA loci showed that they had all been turned into donors. Severe jaundice developed 90 days after transplantation and was diagnosed as acute GVHD combined with cytomegalovirus infection in the liver. Treatment with immunosuppressants and antiviral drugs was supplemented with plasma exchange and artificial hepatic bilirubin adsorption. Complications were controlled. After 24 months of follow-up, the patients were generally in good condition and had normal liver function. Ph chromosome and bcr abl genes in bone marrow cells were negative. Conclusion This case is the first case of successful treatment of adult leukemia with allogeneic CBT in China. It shows that allogeneic CBT is feasible for the treatment of adult hematological diseases.