异基因外周血干细胞移植治疗苯中毒性再生障碍性贫血

目的　研究异基因外周血造血干细胞移植治疗苯中毒致重型再生障碍性贫血 (SAA)。方法　用HLA配型全相合的女性供者异基因外周血造血干细胞移植 (Allo PBSCT)治疗 1例苯中毒致SAA男性患者。输入单个核细胞数为 9.4 1× 10 8 kg、CD34 阳性细胞为 12 .4 9× 10 6 kg、粒 -巨噬细胞系祖细胞集落数为 8.2× 10 5 kg。预处理方案由环磷酰胺加全身照射和抗淋巴细胞球蛋白组成 (环磷酰胺总量 12 0mg kg ,全身照射为 8Gy ,抗淋巴细胞球蛋白总量 6 0mg kg)。为防止植入失败 ,移植后第 18天再次输入供者白细胞层 ,其中单个核细胞数为 9.0 2× 10 8 kg、CD34 阳性细胞为 10 .6 2× 10 6 kg、粒 -巨噬细胞系祖细胞集落数为 6 .3× 10 5 kg,并用环孢菌素A和甲氨蝶呤预防移植物抗宿主病。结果　输入单个核细胞后白细胞最低值为 0 ,血小板最低值为 3× 10 9 L ;中性粒细胞于移植后第 2 1天开始大于0 .5× 10 9 L ,血小板于移植后第 2 8天开始大于 5 0× 10 9 L。移植后第 4个月出现皮肤局限性慢性移植物抗宿主病。受者染色体转为 4 6 ,XX ;ABO血型由B型转为O型。结论　此例为国内首例采用Allo PBSCT治疗苯中毒致SAA并获得成功 ,为苯中毒治疗开辟了新的途径。

The treatment with allogeneic peripheral blood stem cell transplantation for benzene-induced severe aplastic anemia

OBJECTIVE: To evaluate the efficacy of treatment with allogeneic peripheral blood stem cell transplantation for benzene-induced severe aplastic anemia. METHODS: HLA-compatible sibling (pregnancy) allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) was successfully performed for a patient with severe aplastic anemia caused by benzene poisoning. 9.41 x 10(8) nucleated cells/kg, 12.49 x 10(6) CD(34) positive cells/kg and CFU-GM 8.2 x 10(5)/kg were infused. The patient was treated with cyclophosphamide (120 mg/kg), total body radiation (8 Gy) and anti-lymphocyte globulin (60 mg/kg) before transplantation. Donor buffy coat cells (9.02 x 10(8) nucleated cells/kg, 10.62 x 10(6) CD(34) positive cells/kg, 6.3 x 10(5) CFU-GM/kg) were infused again on day 18 after transplantation to prevent from graft failure. Graft versus host disease prophylaxis consisted of both methotrexate and cyclosporin A. RESULTS: The lowest ANC was 0, the lowest platelet was 3 x 10(9)/L after transplantation. The patient achieved an ANC of greater than 0.5 x 10(9)/L from 21st day, and the platelet of greater than 50 x 10(9)/L from 28th day after transplantation. Grade I cGVHD was found the fourth month after grafting. Examination of recipient's bone marrow cells showed a normal 46, XX (presumably marrow donor) karyotype. Blood group changed from B to O. CONCLUSION: This is the first case reported in China showing a successful treatment of benzene-induced severe aplastic anemia with allo-PBSCT. Allo-PBSCT may be an effective remedy for this kind of patients.