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目的:分析非亲缘异基因外周血干细胞移植治疗幼儿急性非淋巴性白血病的可行性。方法:患儿,男,3岁,于2005-07-18为行造血干细胞移植入本院血液科骨髓移植病房,入院诊断为急性非淋巴细胞性白血病-M5b。经抗肿瘤药物治疗病情获得完全缓解。患儿首先接受清髓性预处理,然后接受同性别非亲缘异基因外周血造血干细胞移植。①移植预处理包括马利兰、阿糖胞苷和环磷酰胺。移植前依次用药为马利兰3.2mg/(kg·d)×4d,口服,于移植前6,7,8,9d给药;阿糖胞苷3.2g/(m2·d)×2d,于移植前4,5d给药;环磷酰胺54mg/(kg·d),于移植前2,3d给药。②急性移植物抗宿主病的预防用药包括环孢菌素A和氨甲蝶呤、抗胸腺细胞球蛋白及吗替麦考酚酯。供者接受粒细胞集落刺激因子动员4d后采集外周血造血干细胞,供、受者间HLA全相合,患者血型A,供者血型B,主次要均不合。结果:①患儿移植后早期获得造血重建,中性粒细胞>0.5×109L-1和血小板>50×109L-1的天数分别是12d和11d。②移植后1个月经DNA短串联重复序列多态性分析证明为供者型完全植入,移植后3个月查骨髓象正常。③移植后3,6个月定期行淋巴细胞亚群检查表明除CD19+,CD4+细胞未恢复外,自然杀伤细胞在移植后3个月恢复正常,T淋巴细胞CD3+与CD8+、体液免疫球蛋白在移植后6个月中均获得重建。④整个移植过程顺利,未出现明显感染和重度急性移植物抗宿主病。移植后96d时出现Ⅰ度皮肤移植物抗宿主病,经加用激素治疗,皮疹消失。移植术后已随访观察12个月,患儿正常生活。结论:如果患儿有HLA完全相合的供者,非亲缘异基因外周血干细胞移植治疗儿童高危白血病是一种有效和安全的方法,对国内独生子女家庭拓宽供者来源有重要的实用价值。
Objective: To analyze the feasibility of non-related allogeneic peripheral blood stem cell transplantation in the treatment of acute non-lymphoid leukemia in children. Methods: The children, male, aged 3 years, were enrolled in this study. Hematopoietic stem cells were transplanted into the hematology bone marrow transplantation ward of our hospital from July 2005 to January 18. The patients were admitted to hospital for acute non-lymphocytic leukemia-M5b. The anti-tumor drug treatment of the disease was completely relieved. Children first received myeloablative preconditioning and then received the same-sex non-related allogeneic peripheral blood hematopoietic stem cell transplantation. ① transplant pretreatment, including Maryland, cytarabine and cyclophosphamide. Before transplantation, the medication was followed by maralin 3.2mg / (kg · d) × 4d orally, and administered 6, 7, 8 and 9 days before transplantation. Cyanosine 3.2g / (m2 · d) × 2d 4,5d administration; cyclophosphamide 54mg / (kg · d), 2,3 d before transplantation. ② Acute graft versus host disease prophylaxis including cyclosporine A and methotrexate, anti-thymocyte globulin and mycophenolate mofetil. The donor received peripheral blood hematopoietic stem cells 4 days after mobilization of granulocyte colony-stimulating factor for complete HLA matching between donors and recipients. Blood type A and type B of blood donors were all matched. Results: ①The number of days after hematopoietic reconstitution was obtained in the early stage after transplantation was 12 days and 11 days respectively. The numbers of neutrophils> 0.5 × 109 L-1 and platelets> 50 × 109 L-1 were respectively obtained. ② One month after transplantation, DNA short tandem repeat polymorphism analysis proved that donor type was completely implanted, and bone marrow was normal at 3 months after transplantation. (3) The routine examination of lymphocyte subpopulations at 3 and 6 months after transplantation showed that natural killer cells returned to normal at 3 months after transplantation except for CD19 + and CD4 + cells. CD3 + and CD8 + of T lymphocytes and humoral immunoglobulin After 6 months were rebuilt. ④ the entire transplant process is smooth, no significant infection and severe acute graft-versus-host disease. Ⅰ degree skin graft-versus-host disease occurred 96 days after transplantation. The skin rash disappeared after treatment with hormones. Follow-up after transplantation for 12 months, children with normal life. CONCLUSION: If children with HLA-identical donors are fully matched, unrelated allogeneic peripheral blood stem cell transplantation is an effective and safe treatment for children with high-risk childhood leukemia and has important practical value for broodding the source of donors in the one-child domestic families.