HLA位点不全相合的异基因干细胞移植治疗白血病的临床分析

目的：探讨HLA不完全相合的造血干细胞移植治疗白血病的新方法.方法：将8例白血病患者接受FBC预处理方案后行异基因粒细胞集落刺激因子（G-CSF）动员的骨髓和外周血干细胞联合移植，观察造血重建和移植相关的并发症情况.结果：1例2位点不合患者植入失败，其余7例完全植入，白细胞恢复时间13.5 d，血小板恢复15.1 d，7例患者Ⅰ～Ⅱ度急性移植物抗宿主病（GVHD）发生率57.1%（4/7），局限性慢性GVHD发生率83.3%，未出现严重的心、肝和肺脏并发症.移植后6个月生存率62.5%.结论：用FBC预处理方案和GCSF动员后的骨髓和外周血干细胞联合移植的方法对于HLA不相合的移植安全有效。     

HLA半相合非清髓性造血干细胞与间充质干细胞共移植治疗重症再生障碍性贫血1例

目的:观察HLA半相合非清髓性造血干细胞与间充质干细胞(MSC)共移植治疗重症再生障碍性贫血(SAA)的疗效及安全性。方法:1例24岁男性SAA患者。应用非清髓性预处理方案,进行HLA半相合异基因外周血造血干细胞和MSC共移植。移植rhG-CSF动员的供者外周血单个核细胞9.22×108/kg,CD34 细胞8.56×106/kg,及体外扩增培养的供者骨髓MSC2.12×105/kg。结果:移植后 12d中性粒细胞数>0.5×109/L, 21d WBC4.5×109/L,Hb99g/L,PLT108×109/L。经HLA配型,红细胞亚型和VNTR检测,为供者型完全嵌合体。随访14个月,无急、慢性移植物抗宿主病(GVHD)发生。结论:HLA半相合非清髓性造血干细胞与MSC共移植治疗SAA是安全有效的方法。     

血液系统疾病

20021242异基因外周血造血干细胞移植治疗急性再生障碍性贫血:一例报告附文献复习/赵晓武…刀中华血液学杂志一2001,22(10)一536~538 患者男性,30岁,面色苍白、乏力进行性加重1个月余,血常规和骨髓检查确诊急性再障(S AA~1)。供者为其胞弟,HLA配型完全相合。胞弟接受格拉诺赛特     

非血缘脐血移植失败行二次单倍型造血干细胞移植成功治疗骨髓增生异常综合征1例并文献复习

目的：探讨非血缘脐血移植治疗骨髓增生异常综合征失败后立即行半相合型造血干细胞二次移植作为解救方法的可能性和安全性。方法：1例骨髓增生异常综合征难治性血细胞减少伴多系增生异常（MDS-RCMD）3年余患者,进行非血缘HLA不全相合双份脐血造血干细胞移植,移植后＋30dSTRPCR检测移植物未植入,立即予患者进行半相合造血干细胞干细胞移植以挽救患者生命。供者为患者母亲,采用“骨髓加外周血联合造血干细胞移植”,预处理方案采用“抗胸腺细胞球蛋白＋福达拉滨”。结果：二次移植物成功植入,形成完全供者来源的造血与免疫功能,二次移植后12dANC〉0．5×10^5／L,＋15dPLT〉20×10^9／L,无急慢性GVHD等并发症的发生,随访19月余,患者获得长期无病生存。结论：非血缘脐血移植失败后,50d内行半相合型造血干细胞移植治疗骨髓增生异常综合征是安全、有效的挽救治疗措施。     

他克莫司致反复急性肾衰竭1例

<正>患者男,31岁。因同胞HLA全相合异基因外周血造血干细胞移植术后3月余,食欲下降1周,于2014年4月1日入院。患者于2013年8月确诊为慢性粒细胞白血病慢性期,口服伊马替尼治疗3个月,复查血常规正常,骨髓细胞学完全缓解,但BCRABL融合基因p210阳性,Ph染色体阳性,患者与其胞妹HLA配型6/6相合,于2014年1月行异基因     

间充质干细胞在HLA半相合移植中的应用

造血干细胞移植是治愈恶性血液系统疾病的唯一方法,但寻找HLA完全相合的供者越来越难,HLA半相合移植显示出它独特的优势。骨髓间充质干细胞是骨髓微环境中具有自我更新和多向分化的非造血干细胞,在造血干细胞移植中发挥重要的作用,它能够促进造血重建,与造血干细胞共输注能增强造血干细胞的植入。     

HLA相合同胞异基因造血干细胞移植治疗儿童MDS转变的AML1例

异基因造血干细胞移植(allo-HSCT)已经成为治疗各种恶性血液病最有效的方法之一。我们为1例儿童骨髓异常增生综合征(MDS)转化的急性白血病患者进行同胞HLA相合的异基因外周血干细胞移植(allo-PBSCT)获得成功,现报告如下。患者,男,9岁。因间歇性发热、咳嗽、咳痰、乏力3个月余来     

人类白细胞抗原不合或单倍体亲属供者造血干细胞移植

异基因造血干细胞移植(allo-HSCT)是重症血液病的主要根治性治疗方法。除人类白细胞抗原(HLA)相合的健康同胞为首选供者外,非血缘、脐带血和亲属HLA不合或单倍体造血干细胞都作为重要的干细胞来源进入了临床。美国的统计资料显示只有不超过40%的患者可以找到HLA相合的同胞供者。白人中找到非血缘HLA相合供者的机会约为75%,但在少数人种中这一几率低于50%。尽管如此,非血缘供者的查询过程耗时长,使得许多急性患者无法在最适宜的时机接受移植。脐带血来源的造血干细胞虽然可以立即得到,对供者不构成任何负担而且运输过程污染机会小,但…     

应用亲属HLA单倍体相合外周血干细胞移植治疗恶性血液病的临床研究

为探讨应用亲属HLA单倍体相合外周血干细胞移植（PBSCT）治疗恶性血液病的可行性及疗效，我们于2002年7月至2005年7月对10例恶性血液病患者进行了亲属间HLA单倍体相合PBSCT，并取得了良好的效果。     

HLA不全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不全相合外周血造血干细胞移植(PBSCT)治疗急性白血病(AL)的可行性。方法：应用HLA1个位点不合亲缘供体PBSCT治疗急性白血病2例，采用BUCY加ALG进行预处理，采用环孢素A、甲氨喋呤、霉酚酸酯和抗CD25单抗等联合预防移植物抗宿主病(GVHD)。结果：2例患者均获造血重建，并发Ⅱ度急性GVHD及局限性慢性GVHD。随访19个月均无病生存，恢复正常生活。结论：对缺乏HLA完全相合同胞供体的白血病患者，应用HLA不全相合的亲缘供体PBSCT治疗急性白血病具有一定的应用前景。     

Kidney transplantation after liver transplantation

Kidney transplantation after liver transplanta-tion (KALT) offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efifcacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta-tion because of calcineurin inhibitor (CNI)-induced neph-rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses, maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them. Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.     

Liver transplantation and liver cell transplantation

Liver transplantation is nowadays the recognized treatment of many liver diseases and liver-based metabolic disorders in childhood. The indications are congenital cholestatic diseases, mainly biliary atresia, metabolic disorders and fulminant hepatic failure. Potential candidates have to be evaluated early in a specialized center, as the survival rate is worse if the child is transplanted with end-stage liver failure. The graft is in most cases partial, either a split liver from a deceased donor (the other part going to an adult recipient), or the left lobe or left liver from a living donor. The patient's survival rate is about 80-90% at 1 year, 70-80% at 10 years, and the graft survival rate 60-70% at 10 years. Immuno-suppression depends on a calcineurin inhibitor (cyclosporin or tacrolimus), and either steroids or an induction with a monoclonal antibody against IL2-receptor. Early surgical complications are a non-function of the graft (rare), arterial or portal thrombosis, biliary problems (more frequent with partial grafts), bleeding. Infections with bacteria and fungi are frequent and often severe. CMV infection is prevented, or screened and preemptively treated. EBV infection is frequent and may induce a posttransplant lymphoproliferative disease, that can develop into a lymphoma. Early stages are treated with reduction of immuno-suppression and monoclonal antibodies against CD20. Acute rejection is frequent but usually easily controlled. Chronic rejection may be due to poor compliance. Late graft loss is due to chronic rejection or long-standing biliary complications. Long-term complications are progressive graft fibrosis, renal failure due to drug toxicity (mainly calcineurin inhibitors), and cancers (skin and lymphoma).     

Progress in pancreas transplantation and combined pancreas-kidney transplantation

IntroductionF or many years, pancreas transplantation (PT) results have lagged behind those of other solid organ transplants, particularly for recipients of pancreas transplantation alone (PTA) and pancreas after kidney (PAK). This is related to an increased graft loss following PT, secondary to a high technical failure rate and an increased incidence of acute rejection.[1] More recently, with improvements in preservation, technical aspects of the procedure, and newer immunosuppressive dru…     

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

Reports of hematopoietic stem-cell transplantation (HSCT) following solid-organ transplantation have been described in adults mainly as case reports. These reports demonstrate feasibility but likely do not reflect true outcomes due to a positive reporting bias. We report herein the outcomes of all our pediatric recipients of allogeneic HSCT following previous solid-organ transplantation between 2000 and 2009. Four children were identified. Two patients underwent heart transplantation followed by cord-blood allogeneic HSCT for T-cell lymphoma/post transplant lymphoproliferative disease (PTLD) and two patients underwent liver transplantation followed by living-donor allogeneic HSCT for severe aplastic anemia (SAA). The mean time between transplants was 4.2 years (range 1.5-6 years). All patients engrafted; however, all patients died from 37 days to 1 year after HSCT. Causes of death included infections (n=2), multi-organ failure (n=1) and solid-organ graft rejection (n=1). Though three patients survived beyond day+100, multiple complications were observed including EBV re-activation followed by EBV-positive PTLD (n=1) and five episodes of severe infections. The patients transplanted for lymphoma did not have evidence of recurrence at last follow-up. Although feasibilty has been shown with this cohort, we conclude that allogeneic HSCT in immunosuppressed patients following solid-organ transplantation remains a very high risk procedure that results in severe morbidity and mortality in children.     

胰腺移植和胰肾联合移植的应用进展

胰腺移植作为糖尿病及其并发症的有效治疗方法之一,已日益受到重视。外源性胰岛素注射治疗,虽然可以相对稳定地降低糖尿病患者的血糖,但是无法像移植胰腺一样提供生理性内源性胰岛素分泌,因此对于糖尿病远期并发症的干预效果并不理想。近年来,人们一直致力于研究更为有效的治疗     

Liver transplantation

The 1-year survival rates of around 70% that are now being achieved have resulted in the acceptance of liver transplantation as a treatment for end-stage liver disease. The number of patients undergoing transplantation is increasing rapidly and the indications are widening. More patients are being transplanted for acute liver failure following the recent encouraging reports of successful grafting in this condition. The proportion of patients transplanted for liver cancer is falling as it becomes apparent that 80% of patients will die from recurrent disease. The selection of candidates and timing of transplantation continue to pose difficult clinical problems. Although the surgical and anaesthetic aspects of liver transplantation have been greatly improved, the 30-day mortality remains high at around 30% and postoperative complications, especially infection and rejection, continue to be major problems. However, rehabilitation is excellent for most patients and liver transplantation should no longer be considered an experimental procedure.     

Heart-lung transplantation

In this study the transplantation group of La Pitié Hospital, Paris, review heart-lung transplantation on the basis of data from the literature and of their own experience. Successively, the history, indications, pre-operative evaluation, donor selection, operative procedure with its immediate, mid-term and late complications, as well as treatment and post-operative follow-up are described.     

Heart-lung transplantation

The survival rate (average, 50%) of patients undergoing cardiopulmonary transplantation falls well below that expected for cardiac transplantation alone. We give a broad overview of the various grounds upon which this difference is likely based and discuss recent advances in each area: 1) criteria for the selection of candidates and donors, 2) methods for ex-vivo preservation of donor organs, 3) technical execution of the operative procedure, and 4) prevention of postoperative infection. In connection with the prevention of postoperative infection, we discuss the potential for the development of a chronic obliterative disease that, once established, has proved inexorable. Current efforts are focused on detection when the process is in an early, reversible stage, and on research into causation.     

Heart-lung transplantation

Heart-lung transplantation itself is not a particularly difficult operation technically. It is the setting in which this procedure is performed which is difficult. The three issues of importance in a successful outcome are appropriate harvest of the heart-lung bloc from the donor, careful explant of the heart and lungs of the recipient, and finally the implant of the heart-lung bloc into the recipient. None of this requires extraordinary technical skill, but does require careful coordination and planning as well as adhering to some fundamental principles. One of the major pitfalls encountered is bleeding related to the explant procedure. Another is graft failure related to harvest and/or the implant procedure. The third is injury to either the phrenic nerve(s) or the left recurrent laryngeal nerve related to the explant procedure. Heart-lung transplantation is a major investment in resources of all sorts including financial, personnel, as well as the organs themselves. It is absolutely imperative that this procedure be performed only by experienced surgeons in centers with established expertise.