异基因骨髓移植后巨细胞病毒视网膜炎一例报告并文献复习

目的通过1例异皋因骨髓移植后巨细胞病毒视网膜炎(CMVR)转归及献复习，认识CMVR。方法痫例分析及献复习结果患在使用大量多利，免疫抑制剂之后出现严重全身巨细胞病毒(CMV)感染，眼底检查有沿血管分布的出血及大量渗出，抗CMV治疗后好转。结论异基因骨髓移植后患免疫功能低卜，血、尿CMV检测持续阳性合并眼部症状及典型眼底改变可诊断CMVR。     

慢性粒细胞白血病异基因骨髓移植后残留白血病观察

目的：观察慢性粒细胞白血病（ＣＭＬ）异基因骨髓移植（ａｌｏ－ＢＭＴ）后残留白血病情况。方法：用逆转录－多聚酶链反应（ＲＴ－ＰＣＲ）技术测定４６例经ａｌｏ－ＢＭＴ植活的ＣＭＬ患者骨髓细胞Ｍ－ｂｃｒ／ａｂｌｍＲＮＡ表达。结果：ａｌｏ－ＢＭＴ能使约７０％ＣＭＬ患者在移植后３个月ｂｃｒ／ａｂｌｍＲＮＡ转阴。其中４例患者在移植后＋１．５～２．０个月时为ｂｃｒ／ａｂｌｍＲＮＡ（＋），于＋３个月转为阴性；１例于＋９个月转阴。１例无病存活６年以上患者，其ｂｃｒ／ａｂｌｍＲＮＡ为阳性；另１例无病存活４年以上患者ｂｃｒ／ａｂｌｍＲＮＡ为阴性。结论：ＲＴ－ＰＣＲ是当前检测残留白血病最灵敏的方法，但不能忽视其局限性。     

Successful allogeneic bone marrow transplantation for acute myelogenous leukemia after drug-induced cardiomyopathy

Anthracycline derivatives often induce cardiomyopathy. Patients with seriously decreased cardiac function due to chemotherapeutic drugs cannot usually receive allogeneic hematopoietic stem cell transplantation (SCT) for hematologic disorders. We successfully performed allogeneic bone marrow transplantation (BMT) in a patient with severe cardiomyopathy. An 18-year-old woman with relapsed acute myelogenous leukemia had cardiomyopathy due to previous anthracycline administration. She underwent allogeneic BMT from her HLA-identical brother. Her preconditioning regimen was cytosine arabinoside, etoposide, total body irradiation, and high-dose cyclophosphamide. Congestive heart failure (CHF) was not present before BMT. Right heart pressures were monitored by a pulmonary arterial balloon catheter system (Swan-Ganz catheter). After BMT, she had severe CHF, which was controlled using pimobendan and amrinone. Patients with cardiomyopathy can receive allogeneic SCT under strict hemodynamic management.     

Development of acute myeloid leukemia from donor cells after allogeneic peripheral blood stem cell transplantation in a female patient with acute monoblastic leukemia

Development of leukemia from donor cells is a rare complication of allogeneic blood stem cells (BSC). The paper describes a case of evolving acute myeloid leukemia of a graft in a patient with resistant acute monoblastic leukemia after related allogeneic peripheral BSC transplantation. The rarity of this complication, difficulties in providing evidence for the donor origin of a leukemic clone demonstrate a need for all-round careful dynamic assessment of the hematopoietic system after allogeneic transplantation, by applying the current cytogenetic (fluorescence in situ hybridization) and molecular (hypervariable genomic region amplification test using the polymerase chain reaction, hypervariable number of tandem repeats (VNTR), and short number of tandem repeats (STR)) techniques, which permits errors to be avoided in the assessment of a clinical situation and in the diagnosis of leukemia from donor cells. There is no developed policy for treatment of acute graft-versus-leukemia.     

A case of successful transplantation of allogeneic bone marrow in a patient with myelocytic leukemia

Allogenic bone marrow transplantation was performed in a patient with chronic myelocytic leukemia (Ph+) in a stable phase. A 1,5-year recurrence-free period since the time of transplantation was observed. Transplantation features were as follows: incompatibility of the recipient and donor by ABO-antigens, the development of acute graft versus host disease and transient Ph-positivity.     

异基因骨髓移植小鼠供体骨髓细胞在受体内的分布及淋巴细胞供受体来源比例分析

目的观察小鼠异基因骨髓移植(alloBMT)后供体骨髓细胞在受体内的分布以及嵌合体内T、B淋巴细胞增殖分化规律。方法以绿色荧光蛋白(GFP)转基因C57BL/6J(H2b)小鼠为供体,以137Cs5.5Gy×2照射的BALB/c(H2d)小鼠为受体,分别于移植后3天(+3天)、+7天、+21天、+35天和+70天取外周血、骨髓、胸腺、脾脏、肠集合淋巴结及肝脏,用流式细胞仪和荧光显微镜观察供体来源的骨髓细胞分布。用藻红蛋白标记的抗CD4、抗CD8、抗B220抗体检测+21天小鼠体内骨髓、外周血及其他免疫器官中T、B淋巴细胞的构成比例。结果①+3天、+7天供体骨髓细胞在受体脾脏中分布最多,分别为(1.06±0.02)%、(76.60±1.80)%;骨髓中分别为(0.37±0.06)%、(39.70±5.38)%。②+21天受体骨髓、脾脏、淋巴结、胸腺及外周血中供体细胞达60%～90%。③+3天受体肠集合淋巴结中供体骨髓细胞达(0.36±0.04)%,与受体骨髓中供体骨髓细胞的比例相当。结论①alloBMT后早期供体骨髓细胞可分布到受体的骨髓、脾脏、肠集合淋巴结中,脾脏中最多。②+21天受体内骨髓及其他免疫器官以供体细胞为主。③受体肠道集合淋巴结也是移植后供体骨髓细胞的早期寄居点和B淋巴细胞增殖后的迁移部位。     

Successful allogeneic stem cell transplantation in a case with acute myeloid leukemia and invasive Schizophyllum commune rhinosinusitis

Schizophyllum commune, a basidiomycete fungus, is a quite rare cause of invasive sinusitis for which no standard treatment has yet been established. We report herein a 59-year-old woman who developed S. commune rhinosinusitis after remission induction chemotherapy for her acute myeloid leukemia. No causative microorganisms were identified in the sinus lavage fluid culture, whereas nucleotide sequencing of the internal transcribed spacer region using endoscopic sinus biopsy specimen could confirm the pathogen as S. commune. Liposomal amphotericin B and voriconazole (VRCZ) treatment ameliorated both her clinical symptoms and laboratory findings. The patient was successfully treated with allogeneic stem cell transplantation, under continuous VRCZ administration, without aggravation of S. commune sinusitis. Molecular diagnosis and prompt intervention with suitable antifungal drugs may be crucial to manage this rare infectious complication.     

Successful bridge therapy of gilteritinib to cord blood transplantation in relapsed acute myeloid leukemia after bone marrow transplantation

The FMS-related tyrosine kinase 3 (FLT3) internal tandem duplication mutations (FLT3-ITD) positive acute myeloid leukemia (AML) is a disease with a dismal outcome. Gilteritinib is a second-generation FLT3 inhibitor with activity against ITD and high affinity toward the FLT3 receptor, thereby showing therapeutic potential for relapsed/refractory FLT3-mutated AML. Bone marrow transplantation (BMT) from a human leukocyte antigen (HLA) identical sibling donor was performed in a 38-year-old Japanese male with FLT3-ITD positive AML. Neutrophil engraftment (>0.5 × 10⁹/L) was achieved on day 16, and bone marrow remission was revealed on day 32. The patient's AML relapsed hematologically four months after BMT and was resistant to salvage chemotherapy. Gilteritinib was administered and the patient achieved non-remission but ‘stable disease’ status according to the response criteria. During administration, liver damage was observed but controllable. The patient received cord blood transplantation (CBT) as the second hematopoietic stem cell transplantation (HSCT) three months after relapse and achieved second remission. There was no evidence of recurrence of AML four months after CBT. This case demonstrates that gilteritinib can control FLT3-ITD positive AML that relapsed early after initial HSCT and can bridge to second HSCT.     

Effectiveness of allogeneic bone marrow transplantation in patients with acute leukemia in complete remission and in patients with chronic myeloid leukemia during the chronic phase]

AIM: To study clinical efficiency of allogenic bone marrow transplantation (ABMT) in patients with acute leukemia (AL) in the first remission and in patients with chronic myeloid leukemia (CML) in chronic phase; to analyse overall and recurrence-free survival in relation to the diagnosis and age. MATERIALS AND METHODS: 26 patients with AL and 24 ones with CML (29 males and 21 females) were subjected to ABMT within 10 last years. Median of age in AL and CML was 24.5 and 25.5 years, median of the time since the diagnosis was 9 and 13 months, respectively. Follow-up since the ABMT made up 67.5 months (31-107) and 38 months (6-108), respectively. Conditioning was made with cyclophosphamide (120 mg/kg) plus total radiation of the body (12 Gy) in 16 patients, myelosan (mileran) in a dose 16 mg/kg plus cyclophosphane (120 mg/kg) in 34 patients. The marrow was taken from HLA-identical sibs, enzygotic twins (5 recipients). Cytogenetic investigations were made in CML. The retention of the transplant was controlled by immunological and molecular tests. RESULTS: Among AL patients 50% are still alive. Probability of 80-month survival reached 55%, 110 months--42%. Probable recurrence-free survival was 78%. All the patients are in a complete clinico-hematological remission. Among CML patients 75% are still alive. Of them 89% had a complete hematological remission, 72% are in a complete hematological and cytogenetic remission. Probable 110 month survival equals 75%, probability to survive without recurrence--52%. Early lethality (100 days) of toxic and infectious complications was as low as 10 and 6%, respectively. Frequency of lethal acute secondary disease was under 8%. CONCLUSION: ABMT made in AL patients during the first complete remission and in CML patients in the chronic phase brings about very good results which are much better than after routine cytostatic chemotherapy.     

肝细胞生长因子对急性淋巴细胞白血病小鼠骨髓移植后移植物抗宿主病和移植物抗白血病的影响

目的探讨肝细胞生长因子(HGF)对急性淋巴细胞白血病(ALL)小鼠异基因骨髓移植(alloBMT)后移植物抗宿主病(GVHD)及移植物抗白血病(GVL)的影响及其可能的相关机制。方法随机将20只裸鼠(用于观察白血病复发)分为对照组(A组)和实验组(B组),将20只BALB/c小鼠(用于观察GVHD)分为对照组(C组)和实验组(D组),实验组在移植0天至移植后7天注射HGF,对照组注射PBS。流式细胞术检测HGF对alloBMT后ALL小鼠CD4+、CD8+T淋巴细胞亚群的影响。记录ALL小鼠BMT后的存活时间。观察移植后ALL小鼠肝脏、小肠的GVHD病理变化。ELISA法检测肿瘤坏死因子α(TNFα)的水平。结果A、B、C、D4组小鼠alloBMT后中位生存时间分别为(7.00±1.58),(9.00±1.58),(11.00±3.95),(24.00±13.44)d,D组生存时间明显延长(P值均<0.05)。D组CD4+T淋巴细胞[(10.39±1.15)%]较C组[(13.50±1.81)%]明显降低(P<0.01),CD8+T淋巴细胞[(12.25±2.85)%]较C组[(6.12±1.99)%]明显增加(P<0.01)。D组TNFα水平[(112.10±18.99)pg/ml]明显低于C组[(143.90±25.35)pg/ml](P<0.01)。GVHD明显减轻。结论HGF具有减轻ALL小鼠alloBMT后GVHD程度并且保留GVL的作用。     

混合骨髓移植后过继免疫治疗小鼠白血病

背景：急性白血病自体造血干细胞移植后复发率高,异基因造血干细胞移植后移植相关病死率高,混合造血干细胞移植及移植后过继免疫治疗有可能取长补短,提高疗效。目的：观察自体骨髓混合H-2半相合异体骨髓移植后供体淋巴细胞输注＋白细胞介素2治疗对小鼠白血病的疗效。方法：将Balb/c小鼠经直线加速器照射3Gy后分为白血病模型组、白血病模型照射组、混合移植组、自体骨髓移植组,均尾静脉注射5×10^5K562（GFP＋/NeoR＋）或K562（GFP-/NeoR-）细胞。7d后6Gy照射,自体骨髓移植组移植自体骨髓细胞或联合白细胞介素2治疗;混合移植组移植小鼠自体骨髓细胞混合1/10的H-2半相合异体骨髓细胞后应用白细胞介素2或联合供体淋巴细胞输注治疗。4周后行小鼠外周血及骨髓细胞形态检查,外周血细胞亚群、GFP及NeoR基因测定,肝、脾匀浆细胞GFP和NeoR基因测定。结果与结论：白血病模型组小鼠因骨髓造血功能衰竭于20d内全部死亡,白血病模型照射组小鼠因造血功能衰竭于14d内全部死亡;自体骨髓移植组、混合移植组均有多少不等小鼠无白血病存活超过28d,且混合骨髓移植后及自体骨髓移植后应用白细胞介素2治疗可提高白血病小鼠长期无病生存率,在此基础上联合供体淋巴细胞输注可更进一步提高白血病小鼠长期无病生存率。     

混合骨髓移植后过继免疫治疗小鼠白血病

背景:急性白血病自体造血干细胞移植后复发率高,异基因造血干细胞移植后移植相关病死率高,混合造血干细胞移植及移植后过继免疫治疗有可能取长补短,提高疗效.目的:观察自体骨髓混合H-2半相合异体骨髓移植后供体淋巴细胞输注+白细胞介素2治疗对小鼠白血病的疗效.方法:将Balb/c小鼠经直线加速器照射3 Gy后分为白血病模型组、白血病模型照射组、混合移植组、自体骨髓移植组,均尾静脉注射5×105 K562(GFP+/NeoR+)或K562(GFP-/NeoR-)细胞.7 d后6 Gy照射,自体骨髓移植组移植自体骨髓细胞或联合白细胞介素2治疗;混合移植组移植小鼠自体骨髓细胞混合1/10的H-2半相合异体骨髓细胞后应用白细胞介素2或联合供体淋巴细胞输注治疗.4周后行小鼠外周血及骨髓细胞形态检查,外周血细胞亚群、GFP及NeoR基因测定,肝、脾匀浆细胞GFP和NeoR基因测定.结果与结论:白血病模型组小鼠因骨髓造血功能衰竭于20 d内全部死亡,白血病模型照射组小鼠因造血功能衰竭于14 d内全部死亡;自体骨髓移植组、混合移植组均有多少不等小鼠无白血病存活超过28 d,且混合骨髓移植后及自体骨髓移植后应用白细胞介素2治疗可提高白血病小鼠长期无病生存率,在此基础上联合供体淋巴细胞输注可更进一步提高白血病小鼠长期无病生存率.     

Biological aspects and clinical results of autologous bone marrow transplantation for acute myeloid leukemia

Summary Autologous bone marrow transplantation is a therapeutic approach that permits the administration of high-dose chemo-radiotherapy followed by the infusion of the patient's own marrow, previously collected during remission and cryopreserved. In recent years, autologous bone marrow transplantation has been increasingly used as a treatment for acute leukemias. The mechanisms underlying leukemic relapse represent the most exciting and controversial aspects of autologous bone marrow transplantation. At least three factors may be responsible for leukemic relapse in patients receiving autologous bone marrow transplantation: (1) minimal residual disease; (2) leukemic cells reinfused with the graft; (3) the lack of a graft-versus-leukemia effect. In this paper, the techniques for pharmacological marrow decontamination and the clinical results obtained with autologous bone marrow transplantation will be reviewed.     

阻抑骨髓移植受者白血病细胞免疫逃逸的实验研究

目的　了解转染小鼠可溶性Fas(sFas)基因后的骨髓移植 (BMT)能否阻抑白血病细胞的免疫逃逸 ,从而消灭残留白血病细胞、减少白血病复发。方法　经尾静脉向雌性C57BL 6小鼠体内植入EL4细胞 1 0 5个 只 ,建立移植性小鼠T细胞白血病 淋巴瘤模型。用转染sFas基因的腺病毒 (Ads Fas)感染 2 4h的雄性C57BL 6小鼠 (H 2 b)骨髓单个核细胞 ,对60 Co致死量照射的雌性同系小鼠进行BMT(D组 ) ,同时设立 :空白对照组 (A组 ,无骨髓细胞植入 )、常规BMT组 (B组 ,骨髓细胞未感染病毒 )、白血病组 (C组 ,仅输入EL4细胞 ,不进行照射和BMT)和绿色荧光蛋白 (EGFP)移植组 (E组 ,骨髓细胞感染AdEGFP)。观察各组造血重建情况、白血病 淋巴瘤的发生及小鼠生存率。结果　BMT后 1 0天脾指数检查 ,B、D、E三组之间差异无显著性 (P >0 .0 5) ,各组与A组间差异有显著性 (P <0 .0 1 )。移植后 30天外周血检查 ,B和D组恢复正常 ,C和E组白细胞和血小板均低下。 2个月后嵌合体检查存在Y染色体 ,骨髓细胞学检查B、D两组基本正常 ,C、E两组存在大量的瘤细胞。C组与E组死亡小鼠组织病理学显示脾脏等部位存在瘤细胞 ,而存活的B和D组小鼠基本正常。生存率 :A组全部死亡 ,B组 (6只 )和D组 (1 6只 )全部存活 ,C组存活 2只 (1 2 .5 % ) ,E组存活     

亲溶酶体药物IHW2净化骨髓在白血病患者自体骨髓移植中的应用

目的：观察亲溶酶体药物ＩＨＷ２体外净化急性髓细胞白血病骨髓（ＢＭ）进行骨髓移植（ＡＢＭＴ）的临床疗效。方法：用ＩＨＷ２体外净化ＡＢＭＴ患者的ＢＭ，冷冻保存后回输给患者。结果：３例患者输用净化处理的ＢＭ后均成功地恢复造血功能。２例患者移植后至今已分别持续缓解超过３６、３４个月。其中１例患者移植前染色体为４６ＸＹ，ｄｅｌ（１６）（ｑ２２），移植后２个月检测为４６ＸＹ正常染色体核型。１例患者于移植后１９个月复发。结论：初步研究显示亲溶酶体药物ＩＨＷ２，用于临床移植患者是安全可行的，并且对白血病骨髓有一定的净化作用     

BCL-2抑制剂联合低剂量阿糖胞苷治疗异基因造血干细胞移植后复发老年急性髓系白血病一例报告并文献复习

老年急性髓系白血病(AML)患者治疗困难,长期生存率低,预后差。文献报道,老年AML患者积极进行异基因造血干细胞移植(allo-HSCT)有助于改善远期生存[1]。但是,移植后复发患者通常难以耐受强化疗,很难再次获得完全缓解(CR)。近期我们采用BCL-2抑制剂联合小剂量阿糖胞苷成功治疗1例allo-HSCT后复发的老年AML患者。