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目的 研究HLA不全相合无关脐血移植治疗血液系统恶性肿瘤的疗效、造血重建、免疫重建情况及移植相关并发症。方法 对1例急性淋巴细胞白血病首次缓解的5岁女性患儿行HLA一个位点不合无关男性供体的脐血移植。预处理方案采用BU/CY(BU 16mg·kg~(-1),CY 120mg·kg~(-2),移植物抗宿主病(GVHD)的预防采用CSA+骁悉(MMF)方案:CSA 3mg·kg~(-1)·d~(-1),MMF 250mg·d~(-1)。移植有核细胞数14.6×10~7/kg(受者体重),CD34~+细胞7.24×10~5/kg(受者体重)。结果 移植后+6天～+8天外周血白细胞(WBC)降至0,+27天WBC为1.2×10~9/L,中性粒细胞绝对计数(ANC)>0.5×10~9/L,+39天血小板计数(Plt)>20×10~9/L,+53天Plt>50×10~9/L,+60天Plt>100×10~9/L、Hb>100g·L~(-1)。+12天多聚酶链反应(PCR)检测Y染色体基因阳性;+39天受者外周血VNTR法检测DNA指纹图显示为供者型;+44天受者HLA-DRB1为:0701、0901,为供者白细胞抗原表达;+49天外周血及骨髓染色体核型结果为:46,XY,100％嵌合。+26天出现皮疹及肝肿大,诊断为Ⅱ°GVHD,使用甲基强的松龙2mg·kg~(-1)·d~(-1),症状控制。+98天康复出院。结论 开展HLA不全相合无关供体脐血移植在中国是可行的、有效的、较安全的,脐血的免疫学特性值得深入探讨。
Objective To study the efficacy of hematopoietic reconstitution, immune reconstitution and transplantation-related complications in the treatment of hematological malignancies with HLA-incompatible cord blood transplantation. Methods One case of 5-year-old female with acute lymphoblastic leukemia who had been relieved for the first time underwent cord blood transplantation with unrelated male donors. Pretreatment regimen consisted of BU / CY (BU 16 mg · kg -1, CY 120 mg · kg -2) and prophylaxis of graft versus host disease (GVHD) using the CSA + MMF regimen: CSA 3 mg · kg -1 kg -1 d -1 and MMF 250 mg · d -1 .The number of transplanted nucleated cells was 14.6 × 10 ~ 7 / kg (body weight of recipients), while that of CD34 + cells was 7.24 × 10 ~ 5 / kg body weight.Results Peripheral blood leukocytes (WBC) decreased to 0 on day 6 and day 8 after transplantation, WBC was 1.2 × 10 9 / L on day 27, neutrophil absolute count (ANC )> 0.5 × 10 ~ 9 / L, Plt> 20 × 10 ~ 9 / L on day 39, Plt> 50 × 10 ~ 9 / L on + 53d, Plt> 100 × 10 ~ 9 on day 60 /L,Hb>100g·L~(-1).+ 12 days by polymerase chain reaction (PCR) Y chromosome gene positive; +39 days recipient peripheral blood VNTR DNA fingerprinting showed donor type; +44 HLA-DRB1 was 0701,0901 in donor recipients, which was expressed on donor’s leukocyte antigen. The chromosome karyotype of peripheral blood and bone marrow on day 49 was 46, XY, 100% chimeric. , Diagnosed as Ⅱ ° GVHD, the use of methylprednisolone 2mg · kg -1 · d -1, control of symptoms. 98 days of rehabilitation and discharge.Conclusion To carry out HLA incompatibility donor unrelated donor cord blood transplantation In China is feasible, effective, safer, cord blood immune Characteristics worthy of further exploration.