2例异基因造血干细胞移植后的植入状态监测及近期胸腺功能重建

目的 监测异基因造血干细胞移植后的植入状态,评价移植后的近期胸腺功能重建.方法 对1例接受人类白细胞抗原(human leukocyte antigen,HLA)半相合亲缘供者与1例HLA全相合非亲缘供者异基因造血干细胞移植(allo-HSCT)治疗的白血病患者,收集供者和受者术前、受者移植后1个多月、受者移植后4个多月的EDTA抗凝静脉血,同时采集10例正常健康志愿者的EDTA抗凝静脉血作为正常对照.采用STR-PCR技术检测20个常染色体STR基因座及1个性别基因座的基因型.采用实时荧光定量PCR方法检测受者不同时期和10例正常健康志愿者的T细胞受体DNA重排删除环(TREC)水平.结果 2例造血干细胞移植病例监测在移植后1个多月及4个多月均完全表现为供者源型.造血干细胞移植后1个多月及4个多月,半相合供者的白细胞及血小板恢复晚于HLA全相合供者.2例病人移植前TREC相对定量略低于年龄相近的正常对照组,移植后1个多月及4个多月TREC水平明显升高,其中HLA全相合移植病人TREC相对定量高于HLA半相合移植病人.结论 移植后1个多月及4个多月供者造血干细胞在受者体内完全植活.全相合造血干细胞移植后造血及免疫重建快于半相合造血干细胞移植.     

复合扩增荧光标记STR-PCR定量检测无关供体脐带血移植后供受体嵌合状态

近年来，脐带血移植(CBT)治疗血液系统良、恶性疾病取得较大进展，无关供体脐带血已成为造血干细胞的重要来源。但由于脐血中有核细胞数量少，CBT多数HLA不全相合，增加了植入失败及移植物被排斥的可能。临床需要一种敏感可靠的方法检测移植后供体细胞嵌合状态，以早期判断植入与排斥。我们2002年4月对1例重型再生障碍性贫血(SAAⅡ)患儿实施HLA不全相合的CBT，并应用复合扩增荧光标记STR-PCR结合毛细管电泳的方法，首次定量检测了CBT后供体细胞嵌合率(DC)，现报告如下。     

STR基因位点检查在异基因造血干细胞移植中的应用

目的 探讨短串联重复序列(STR)基因位点检查在异基因造血干细胞移植中的应用。方法 采用PCR方法对4例异基因造血干细胞移植、1例非清髓造血干细胞移植的供者和受者移植前、后STR基因进行检测，了解造血干细胞植入情况。结果 4例异基因造血干细胞移植的受者移植后STR基因型与受者移植前STR基因型不同，与供者STR基因型完全相同，提示供者造血干细胞的植入；1例非清髓造血干细胞移植的受者移植后STR基因型表现为患者移植前STR基因型和供者STR基因型的嵌合状态。结论 STR基因位点检查可以用来判断异基因造血干细胞移植的植入情况。     

异基因造血干细胞移植后红系恢复影响因素分析

目的探讨异基因造血干细胞移植后影响红系恢复时间的因素。方法回顾分析53例异基因造血干细胞移植患者的移植方式、人血细胞抗原（HLA）相合与否、ABO血型相合与否及亲缘关系的有无对红系恢复时间的影响。结果影响红系恢复时间的因素主要为ABO血型主要不合及受、供者的亲缘关系。结论ABO血型主要不合和非亲缘骨髓移植的患者红系恢复较慢。     

骨髓移植后纯红细胞再生障碍性贫血的特点

在HLA表型一致的异基因骨髓移植（bone mar-row transplatation,BMT）中,供、受者间ABO血型不合者占10％～15％,纯红细胞再生障碍性贫血（purered cell aplasia,PRCA）是其主要并发症之一,发病率大约为5％～16％[1,2]。本文就PRCA的临床特点、发病机制及治疗作一简要综述。1 临床特点 ABO血型不合骨髓移植后红细胞生成开始时间一般在15～60天[1]。如果骨髓移植60天后外周血仍未测到供者红细胞,骨髓象显示红系明显减少或缺如,而粒系、巨核系发育正常,此时应考虑到发生了移植后PRCA。PRCA的发病有两种:①受者在骨髓移植后一直贫血,定期监测红细胞抗原2个月内未发现供者红     

HLA-DR重复错配导致再次肾移植超急性排斥2例(摘要)

本文报告2例再次肾移植发生超急性排斥,可能与两次供者的HLA抗原相同而与受者不相合有关。2例均为男性,年龄分别为36和20岁。分别于第1次肾移植发生排斥反应切除移植肾后2个月和23个月行第2次肾移植。供受者血型相同,淋巴细胞毒性试验均为0.01。例1于肾     

ABO血型检测在异基因造血干细胞中的应用及移植后的输血

目的监测ABO血型不合的患者异基因造血干细胞移植前后ABO血型的变化,探索移植后的输血方案,为患者输注合适的血液成分提供依据。方法干细胞移植前检测患者ABO血型,植活后再次检测患者ABO血型抗原及抗体的变化,对输注血液成分的种类和数量进行统计学分析。结果 28例ABO血型不合的患者干细胞移植后35~193 d血型成功转变为供者血型,ABO主要不合、ABO次要不合及ABO主次要不合的受者输注红细胞、血浆和血小板的量和ABO相合组的输注量相比无统计学差异(P<0.05)。结论 ABO血型不合的干细胞移植后,患者血型成功转变为供者血型,相容性输血可以用于异基因造血干细胞移植并能够确保输血安全。     

外周血造血干细胞捐献者的护理

<正>顺利对供者进行造血干细胞采集是保障异基因造血干细胞移植成功的关键之一;同时,由于供者自身是健康人群,故在捐献造血干细胞时担心对自己身体有损害,做好供者的护理是十分重要的。自2008-01～2009-01笔者所在医院对18例健康异基因造血干细胞供者进行了采集,18例均与受者经HLA配型证实为完全相合。现报告如下。     

HLA半相合外周血造血干细胞移植治疗急性白血病的临床观察

目的：探讨HLA半相合外周血造血干细胞移植（peripheral blood stem cell transplantation，PBSCT）治疗急性白血病的效果及安全性。方法：4例急性白血病行HLA半相合PBSCT，其中急性淋巴细胞白血病2例，急性非淋巴细胞白血病2例，移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例，3个位点不合2例。预处理方案由全身照射或白消安、阿糖胞苷、环磷酰胺、甲基洛莫司汀组成。移植物抗宿主病（graft versus hostdisease，GVHD）的预防采用环胞素、甲氨蝶呤、麦考酚吗乙酯、抗胸腺细胞球蛋白四联方案。结果：4例均获得造血功能重建。2例出现Ⅰ度急性GVHD，2例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎，2例并发真菌肺炎。至今3例无病存活29、15和2个月，1例死亡。结论：HLA半相合PBSCT疗效较好、安全可行，为无HLA完全相合供者的白血病患者提供了新的治疗手段，但要特别注意移植后病毒和真菌感染的防治。     

HLA半相合异基因造血干细胞移植并发症的预防

异基因造血干细胞移植是治疗白血病的有效方法，在缺乏HLA配型完全相合供者的情况下只得用HLA半相合异基因造血干细胞移植，但易发生移植物抗宿主病(GVHD)、出血性膀胱炎(HC)、肝静脉闭塞病(VOD)等严重并发症而导致移植失败。本文报告HLA半相合异基因造血干     

自体髂骨及骨髓移植配合中药治疗胫骨骨不连的临床研究

目的研究观察采用自体髂骨及骨髓移植配合中药治疗胫骨骨不连的临床疗效。方法将我科自2010年1月到2012年1月收治的21例胫骨骨不连患者采用自体髂骨及骨髓移植并重新内固定,术后配合口服自拟中药方治疗,观察患者的临床愈合率及愈合时间。结果 21例患者其中19例最终愈合,2例发生再次不愈合,愈合率为90.5%,平均愈合时间为5.9个月。结论自体髂骨及骨髓移植配合中药治疗胫骨骨不连可以取得良好的临床疗效。     

Successful bone marrow transplant for Fanconi's anaemia.

A 15-year-old boy with Fanconi's anaemia, who required four units of blood each month, received a bone marrow graft from his 9-year-old brother, who has HLA identical and compatible on mixed lymphocyte reaction. Considerable immunosuppression was used and bacterial infection was prevented by vigorous decontamination in a Vickers-Trexler isolator. After the graft the patient's blood counts remained satisfactory for nine months, but it took six months before qualitative immune function was normal.     

Biological significance of Ss (serum soluble) HLA-class I antigens in bone marrow transplantation

Ss (serum soluble) HLA-class I antigens were investigated in 10 cases of bone marrow transplantation and the relationships among Ss HLA antigens, lymphocyte counts, GvHD and the clinical course were compared. Cs (cell surface) HLA antigens were typed by the NIH standard microcytotoxicity test. Measurement of Ss HLA antigens was performed by both the lymphocytotoxicity inhibition test and solid phase RIA. A good correlation was found between the cytotoxicity inhibition test and solid phase RIA. No correlation was observed between lymphocyte counts and changes in the Ss HLA antigens in the presence of GvHD. In cases with GvHD, Ss HLA antigens were found to correlate with the GvHD. Ss HLA antigens also correlated with levels of lymphocyte counts in cases without GvHD. Ss HLA antigens are an important marker of biological significance in GvHD following bone marrow transplantation.     

异基因造血干细胞移植治疗儿童白血病疗效观察

目的观察异基因造血干细胞移植治疗儿童白血病的疗效。方法在3例行异基因造血干细胞移植的白血病患儿中,2例行无血缘相关人类白细胞相关抗原（HLA）不全相合脐血造血干细胞移植,1例行同胞HLA全相合骨髓造血干细胞与外周血造血干细胞联合移植。移植后进行对症治疗及相关并发症的预防。结果 3例患儿均获造血重建,其中病例1在＋37d全血恢复正常;病例2在＋90d外周血供体嵌合率（STR）97.8%,脐血造血干细胞完全稳定植入。病例3在＋80d外周血STR：99.4%,造血干细胞完全稳定植入。结论异基因造血干细胞移植是一种治疗儿童白血病的较好方法,可以提高白血病患儿的长期生存率。     

Immunogenetic composition of 94 consecutive Danish families investigated with respect to bone marrow transplantation

The immunogenetic composition of 94 patients needing bone marrow transplantation and their core families primarily investigated to select family bone marrow donors have been further analysed to test for association between disease and HLA-region markers. From this material it is shown, that in the primary immunogenetic analysis of the family, inclusion of mixed lymphocyte culture analysis increases donor possibilities by approximately 14% when a reciprocal negative MLC response and phenotypic HLA-DR compatibility are accepted as criteria for transplantation. Further, the results indicate, that no association between HLA and leukemia seems to exist.     

Clinical potential of the HA-1 peptide,a minor histocompatibility antigen

Minor histocompatibility (H) antigens are the targets of host versus graft (HVG), graft versus host (GVH) and graft versus leukaemia (GVL) immune responses following transplantation of organs or tissues between donor/recipient pairs matched for transplantation antigens encoded by the major histocompatibility complex (MHC: HLA in humans). There is a particular clinical problem in predicting and treating GVH disease, which occurs in a significant proportion of bone marrow transplant (BMT) patients, even those with HLA-identical sibling donors. However, many of these recipients receive BMT as part of the treatment for leukaemia and there is a correlation in them between harmful GVH and potentially therapeutic GVL, implying the same target antigens. The molecular identity of minor H antigens is therefore a key issue. This patent describes the recent identification of one of the human minor H antigen (HA-1) and proposes methods for using the nonameric peptide identified, VLHDDLLEA, or analogues of it, to modulate HVG and GVH responses, to promote GVL and, with knowledge of the polymorphism of the encoding gene, to type BMT recipients and their potential donors for presence of the antigen.     

Objective monitoring of graft-versus-host disease: alpha 1-antichymotrypsin concentration changes after bone marrow transplantation in patients developing graft-versus-host reactions

The levels of alpha 1-antichymotrypsin (ACT) was monitored in patients who underwent bone marrow transplantation. Seven received HLA-identical sibling bone marrow grafts, two received transplants from twins and one was given HLA-nonidentical marrow from his father. A dramatic increase of ACT was observed in all patients who developed graft-versus-host disease (GvHD). ACT did not rise at all in the case of patients who received marrow from twins, even in a patient who was given three transplants from the same donor. The patient transplanted from his father died from GvHD and the increase of ACT was the greatest fluctuation measured.     

Recombinant human granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lymphoid cancer: an economic analysis of a randomised, double-blind, placebo-controlled trial

In a blinded retrospective economic evaluation of a double-blind, randomised, placebo-controlled clinical trial, total utilisation and charges for lymphoid cancer patients who received recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) or placebo were compared following autologous bone marrow transplantation. The 40 patients enrolled (22 rhGM-CSF, 18 placebo) could have acute lymphoblastic leukaemia, non-Hodgkins lymphoma or Hodgkin's disease, be of any age, and were undergoing autologous bone marrow transplantation in a metropolitan cancer research centre. Main outcome measures consisted of initial hospital lengths of stay (LOS), total and department charges, rehospitalisation rates and charges, and outpatient charges, all inclusive of the first 100 days following bone marrow infusion. The perspective of the study is that of the third party payer. Initial hospitalisation charges were $US54 100 for patients who received rhGM-CSF and $US68 600 for patients who received placebo (p = 0.05). The difference of $US14 500 was 21% less in patients who received rhGM-CSF, mainly due to lower average LOS with rhGM-CSF (24.2 days) compared with placebo (30.8 days). Outpatient charges were $US9500 (rhGM-CSF) and $US6800 (placebo) {p = 0.18}. Total charges, including readmission (10 per group) were $US12 200 lower in the rhGM-CSF group ($US70 300 vs $US82 500, p = 0.19). The use of rhGM-CSF after autologous bone marrow transplantation was shown to result in substantial cost savings during the initial hospitalisation. When comparing total inpatient and outpatient medical charges within the first 100 days following bone marrow infusion, we found no evidence that these savings were negated.     

生物陶瓷加骨髓复合移植物的临床应用

目的：评价生物陶瓷加骨髓复合移植物对粉碎性骨折、骨缺损的成骨作用。方法；植入复合移植物治疗粉碎性骨折及骨缺损32例，并行相应内固定，平均随访9个月，观察骨修复情况。结果：术后伤口均Ⅰ期愈合，平均8周X线片示桥梁骨痂形成，体检达临床愈合标准，无并发症发生，结论：本复合移植物兼具骨诱导及骨传导作用，相容性好，无毒副作用，是一种理想的骨移植替代材料。