非亲缘脐血造血干细胞移植治疗儿童非霍奇金淋巴瘤1例报道

目的观察非亲缘异基因脐血造血干细胞移植治疗儿童非霍奇金淋巴瘤的临床效果。方法 1例5岁非霍奇金淋巴瘤（Ⅳ期）患儿接受了高剂量放化疗联合非亲缘异基因脐血造血干细胞移植的治疗。结果静脉输注脐血后无异常反应。白细胞植入时间为移植后17d,血小板植入时间为移植后25d。移植后出现Ⅰ度急性移植物抗宿主病（GVHD）,分别于24d、40d采集患者外周血,经短串联重复序列GeneScan方法分析判定供者造血干细胞在患者体内存活。患儿移植后43d出院,随访至2010年6月,已无病存活67个月,至今状况良好,无复发、无并发症、无慢性GVHD发生。结论大剂量化疗联合非亲缘异基因脐血造血干细胞移植治疗非霍奇金淋巴瘤儿童患者的移植效果较好,并发症较少。     

亲缘单倍体相合外周血造血干细胞移植治疗重症再生障碍性贫血

【摘要】目的探讨改良白消安／环磷酰胺＋抗胸腺细胞球蛋白（Bu／Cy＋ATG）预处理方案在亲缘单倍体造血干细胞移植治疗重症再生障碍性贫血（SAA）临床应用中的有效性和安全性。方法回顾分析河北唐山钢铁集团有限责任公司医院血液肿瘤科自2009年10月至2011年5月间采用亲缘单倍体外周血干细胞移植治疗的3例SAA患者资料。供者均为母亲,1例HLA3／6位点相合,2例HLA4／6位点相合。预处理方案均为改良Bu／Cy＋ATG,具体为白消安0．8m∥kg,每天4次,连用2d;环磷酰胺50mg·kg-1·d-1,连用4d;抗胸腺细胞球蛋白2．5mg·kg-1·d-1,连用4d。环孢素＋短程甲氨蝶呤＋吗替麦考酚酯预防排斥反应。结果3例患者均达完全供者植入,2例合并Ⅱ-Ⅲ度急性移植物抗宿主病（GVHD）,1例患者合并局限型慢性GVHD。3例患者均发生血CMV感染,经抗病毒治疗均得以控制。随访5～25个月,3例患者至今均无病存活。结论初步经验Bu／Cy＋ATG预处理方案经改良用于亲缘单倍体外周血造血干细胞移植治疗SAA安全、有效。     

二次移植成功治疗急性白血病单倍体造血干细胞移植植入失败

目的 探讨急性白血病患者首次单倍体造血干细胞移植后植入失败的二次移植治疗策略。方法 2例急性白血病患者首次单倍体造血干细胞移植的2例供者均伴有地中海贫血,分别采集CD34+细胞2.57×106/kg和1.99×106/kg,首次单倍体造血干细胞移植植入失败。二次移植更换为非地中海贫血供者,分别采集CD34+细胞4.28×106/kg和5.75×106/kg,采用减低剂量氟达拉滨（Flu）+白消安（Bu）+抗胸腺细胞球蛋白（ATG）预处理方案行二次移植。结果 2例患者二次移植中性粒细胞和血小板植入时间分别为+12 d和+10 d、+10 d和+10 d。截止至末次随访时间（分别为二次移植+1 062 d、+265 d）,2例患者原发病均完全缓解,无明显移植并发症。结论 减低剂量预处理的二次移植能够成功治疗急性白血病单倍体造血干细胞移植植入失败。     

异基因造血干细胞联合脐带间充质干细胞移植术后并发症的护理

异基因造血干细胞移植是目前治疗恶性血液病的最有效手段，但是仅有25％的患者能找到人类白细胞抗原（HLA）全相合的亲缘供者从而顺利实施移植。因此HLA单倍体相合移植越来越受到重视，但移植后排异反应及并发症严重影响患者的生活质量，甚至威胁生命。人脐带间充质干细胞（MSC）具有多能干细胞特性，输注后可重建骨髓微环境、促进移植后造血干细胞的植入，减少相关并发症的发生。     

亲缘间单倍体相合造血干细胞移植治疗急性淋巴细胞白血病合并骨髓坏死2例

异基因造血干细胞移植是恶性血液病患者获得治愈的最有效手段,在临床上已广泛开展。急性白血病合并骨髓坏死（bone marrow necrosis,BMN）的病例临床有不少报道,但异基因造血干细胞移植治疗此类病例报道鲜见。我们于2011年收治了2例急性淋巴细胞白血病（acute lymphoblastic leukemia。ALL）合并BMN患者,经化疗诱导BMN逆转后为其实施了亲缘间单倍体相合外周血造血干细胞移植,均成功重建造血功能,现报道如下。     

造血干细胞移植患儿创伤后应激障碍变化及影响因素分析

目的 调查造血干细胞移植患儿创伤后应激障碍状态及影响因素，为实施针对性干预提供参考。 方法 选取造血干细胞移植患儿148例，应用创伤后应激障碍症状自评量表在造血干细胞移植前（入层流室前1～2 d，T1）、移植后2～3周（T2）、移植后3个月（T3）进行调查，并分析其影响因素。 结果 造血干细胞移植患儿在T1、T2、T3创伤后应激障碍发生率分别为12.8%、69.6%、10.1%。年龄对患儿移植前及移植后3个月创伤后应激障碍产生影响，照顾者与患儿关系对其移植后2~3周产生影响（均P＜0.05）。 结论 患儿移植期间创伤后应激障碍水平呈动态变化，在造血干细胞移植过程中，护理人员应重视年长儿以及母亲照顾者患儿的心理护理。     

造血干细胞移植治疗儿童髓系白血病26例疗效分析

目的 了解造血干细胞移植对儿童急性髓系白血病(AML)和慢性粒细胞白血病(CML)的治疗效果.方法 髓系白血病患儿26例,平均年龄为9.8岁,其中CML 8例,AML18例.CML患儿中,第1次慢性期(CPl)6例,加速期(AP)1例,第2次慢性期(CP2)1例;AML患儿中,第1次缓解(CRl)9例,第2次缓解(CR2)7例,2例未缓解(NCR).26例中,2例接受HLA全相合同胞供者的外周血与骨髓干细胞联合移植;2例接受由HLA半相合母亲供者外周血干细胞分离出的CD34+细胞输注;2例接受脐血移植;其余20例接受外周血造血干细胞移植.每例移植有核细胞(6.8±6.0)×108/kg,CD34+细胞(4.0±5.8)×106/kg,CD3+细胞(2.6±3.8)×108/kg.所有患儿均采用白消安及环磷酰胺进行清髓性预处理.移植后采用环孢素A和甲氨蝶呤联用预防移植物抗宿主病(GVHD),接受无关供者造血干细胞移植者加用抗胸腺细胞球蛋白,6例CML患儿加用霉酚酸酯.若发生Ⅱ度以上GVHD,则给予甲泼尼龙或巴利昔单抗治疗.结果 除2例HLA半相合移植失败外,其余24例均获得造血功能重建.24例植入成功的患儿中,2例未发生急性GVHD(aGVHD),15例(62.5%,15/24)出现Ⅰ～Ⅱ度aGVHD,7例(29.2%,7/24)出现Ⅲ～Ⅳ度aGVHD(重度aGVHD).7例重度aGVHD均为CML患儿.26例平均随访20.5个月,其中原发病复发死亡者4例,治疗相关死亡者5例,尚有17例(65.4%,17/26)患儿无病存活.结论 异基因造血干细胞移植有助于提高髓系白血病患儿的存活率,只要加强预防,无关供者造血干细胞移植产生的GVHD是可以控制的.而对于高危患儿,无关供者造血干细胞移植的效果与亲缘相关供者移植相似.     

造血干细胞移植治疗重型再生障碍性贫血

目的 探讨不同类型的造血干细胞移植(HSCT)治疗重型再生障碍性贫血(sAA)的预处理方案、预后及并发症发生情况等.方法 回顾性分析2001年9月至2010年11月间41例sAA患者接受HSCT的病例资料及其临床特点,移植类型包括同基因移植6例,同胞全相合移植8例,非亲缘移植18例,亲缘半相合移植7例,自体脐带血移植1例及非亲缘脐带血移植1例.所有受者均采用以环磷酰胺+抗胸腺细胞球蛋白为主的预处理方案,其中23例加用氟达拉滨(Flu),2例加用全身照射,5例加用Flu和全身照射,1例加用Flu和白消安.结果 移植后白细胞和血小板均植活的受者共有38例,其中6例(15.8％)发生排斥反应,分布于同基因移植、同胞全相合移植、非亲缘移植和亲缘半相合移植等多种移植类型;4例发生Ⅲ～Ⅳ度aGVHD,分别为同胞全相合移植1例,非亲缘移植1例,亲缘半相合移植2例;25例发生巨细胞病毒(CMV)血症,8例发生EB病毒(EBV)血症,其中6例为非亲缘移植,1例同胞全相合移植及1例亲缘半相合移植,发生EBV感染的受者均伴有CMV感染.所有受者5年预期存活率为75％,其中同基因移植、同胞全相合移植及非亲缘移植受者的5年预期存活率分别为75％、100％和70％,亲缘半相合移植受者的4年预期存活率57％.结论 sAA患者接受同胞全相合移植后长期存活率高,可以作为sAA的首选治疗方式.而非亲缘移植和亲缘半相合移植的预后还有改善的空间,需要通过选择合适的供者和预处理方案来降低移植后相关并发症的发生率,从而改善预后.     

干细胞移植改善股骨头坏死缺血状态122例临床观察

目的探讨经动脉自体骨髓干细胞（BMSC）和外周血干细胞（PBSC）移植改善股骨头坏死缺血状态的临床疗效。方法2004年7月至2006年12月对122例（211髋）成人缺血性股骨头坏死（ANFH）患者施行自体BMSC或PBSC移植治疗,按国际分期标准（ARCO）分期,设自身前后对照方法进行疗效观察。BMSC组90例和PBSC组32例在DSA下行股骨头供血动脉干细胞移植术,移植后第3、6、12、24个月进行髋关节Harris评分做疗效评价,6个月复查股骨头供血动脉造影观察血管新生情况。每间隔6个月复查影像学变化。结果122例患者随访3～24个月（平均10．2个月）,髋关节疼痛缓解104例（85．1％）,关节功能改善76例（62．0％）,90例（73．9％）行走间距延长。干细胞移植术后6个月,15例患者股骨头供血动脉造影检查见供血动脉较移植前明显增多、增粗,血流速度增快;12～24个月20例股骨头区可见骨质病变获得改善。结论经动脉自体BMSC和PBSC移植方法简便,安全有效,对缺血性股骨头无再次损伤,患者依从性好,是治疗缺血性股骨头坏死的一种新途径。     

造血干细胞移植后并发带状疱疹临床分析

目的 探讨造血干细胞移植后带状疱疹发病情况、临床特点、治疗及转归.方法 回顾分析浙江省中医院血液科可评估的104例接受造血干细胞移植患者预处理方案、移植物抗宿主病预防方案及病毒感染的防治方案等临床资料.结果 104例接受造血干细胞移植患者中有24例(23.08% )并发带状疱疹,其中单倍体相合造血干细胞移植患者带状疱疹发生率为47.6%,非亲缘造血干细胞移植患者带状疱疹发生率为42.1%.应用抗病毒药物,适当减少免疫抑制剂用量及输注人免疫球蛋白,外用干扰素,同时中医中药辅助治疗,平均治疗(20.5±3.8)d后,患者疱疹全部消退,有4 例出现严重疱疹后神经痛,其中2例伴有局部肌肉萎缩.无泛发性疱疹及内脏受累病例,无疱疹相关死亡.结论 造血干细胞移植后发生的带状疱疹起病不典型,综合治疗能够有效地控制,但神经痛持续时间较长.     

Distribution of infused umbilical cord mesenchymal stem cells in a rat model of renal interstitial fibrosis

Abstract

Aims: Stem cell transplantation for the treatment of kidney diseases is dependent on choice of transplant pathway. We evaluated the safety of human umbilical cord mesenchymal stem cells through peripheral infusion and their distribution in a rat model of renal interstitial fibrosis (RIF). Method: Cryopreserved umbilical cord mesenchymal stem cells were infused via tail vein injection into rats with unilateral ureteral obstruction and Sham-operated. Blood, kidney, heart, liver, spleen and lung were collected at 14, 21, and 28 days after infusion. Testing included microscopic observation of kidney morphological changes and immunohistochemical testing to identify and count the number of MAB1281 (labeled human cells) positive cells in the heart, liver, spleen, lungs, and kidneys of different treatment groups. Results: There was no significant difference in the Sham-operated group and Sham-operated?+?cell transplantation group at different time points. Human cells were identified mainly in the lungs, spleen, and kidney. The number of human umbilical cord mesenchymal stem cells in the kidney was greater in the unilateral ureteral obstruction?+?cell transplantation group, compared to the Sham-operated?+?cell transplantation group. human umbilical cord mesenchymal stem cells were mainly located in the interstitium of the left kidney. These results suggest that infused mesenchymal stem cells were primed to engraft a damaged kidney, especially damaged renal interstitium. Conclusions: Intravenous infusion of exogenous umbilical cord mesenchymal stem cells is feasible and safe. Infused mesenchymal stem cells can reach damaged kidney tissues with obstructive RIF after a vein graft.     

HRCT Features of Acute Rejection in Patients With Bilateral Lung Transplantation: The Usefulness of Lesion Distribution

Purpose

This study sought to evaluate the high-resolution computed tomography (HRCT) features of acute rejection and to assess the diagnostic accuracy of HRCT for acute rejection considering distribution of lesions in patients with bilateral lung transplantation (BLT).

Materials and Methods

Between March 2010 and June 2012, 48 transbronchial lung biopsies (TBLBs) and HRCT were performed simultaneously in 26 patients who underwent BLT. We evaluated the presence of ground glass opacity (GGO), consolidation, nodule, bronchial wall thickening, interlobular septal thickening, pleural effusion, atelectasis, bronchiectasis, and cardiomegaly on the HRCT images. The distribution of lesions was analyzed according to bilaterality or upper/lower predominance. Acute rejection was determined on the basis of the pathologic results of TBLB. We evaluated potential correlations of HRCT features with acute rejection, then assessed overall diagnostic accuracy of various HRCT features in combination to diagnose acute rejection in the transplanted lung.

Results

Among the 48 TBLBs, 8 were diagnosed as acute rejection (A1, 4 cases; A2, 2 cases; and A3, 2 cases) pathologically. Two A1 rejections and one A2 rejection appeared normal on computed tomography images. Without considering the distribution of lesions, interlobular septal thickening was significantly associated with acute rejection (P = .010) only. Regarding the distribution of lesions on HRCT images, not only interlobular septal thickening but also GGO was significantly associated with acute rejection (P < .05). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the HRCT scan in the evaluation of acute rejection were 50%, 97.5%, 80%, 90.1%, and 89.6%, when the bilateral GGO and interlobular septal thickening with lower predominance were considered as the positive finding.

Conclusions

HRCT findings considering lesion distribution could be a useful tool in diagnosing acute rejection in patients with BLT.     

The treatment of neurodegenerative disorders using umbilical cord blood and menstrual blood-derived stem cells

Stem cell transplantation is a potentially important means of treatment for a number of disorders. Two different stem cell populations of interest are mononuclear umbilical cord blood cells and menstrual blood-derived stem cells. These cells are relatively easy to obtain, appear to be pluripotent, and are immunologically immature. These cells, particularly umbilical cord blood cells, have been studied as either single or multiple injections in a number of animal models of neurodegenerative disorders with some degree of success, including stroke, Alzheimer's disease, amyotrophic lateral sclerosis, and Sanfilippo syndrome type B. Evidence of anti-inflammatory effects and secretion of specific cytokines and growth factors that promote cell survival, rather than cell replacement, have been detected in both transplanted cells.     

第三方脐血细胞辅助输注对小鼠单倍型造血干细胞移植后造血重建的影响

目的分析以脐血细胞作为第三方细胞辅助输注对小鼠单倍型造血干细胞移植后造血重建的影响。 方法以CB6/F1雄性小鼠为供鼠,以BALB/C小鼠为受鼠。受鼠经Co60全身照射清髓后回输供鼠干细胞,建立单倍型造血干细胞移植模型。将40只受鼠分为对照组和实验组,每组各20只,对照组受鼠回输供鼠干细胞,实验组受鼠回输供鼠干细胞＋脐血单个核细胞。于移植后＋7 d、＋14 d、＋21 d、＋28 d和＋50 d对存活受鼠进行断尾采血,检测白细胞、血红蛋白和血小板,分析造血重建情况。处死小鼠时取外周血1 mL,采用荧光原位杂交技术检测Y染色体比例,计算嵌合率。两组受鼠各时间点白细胞、血红蛋白及血小板检测结果采用成组t检验进行比较,嵌合率采用卡方检验进行比较。P<0.05为差异有统计学意义。 结果移植后＋14 d实验组和对照组白细胞数量分别为(8.4±2.6)×10⁹/L和(3.8±1.0)×10⁹/L,差异有统计学意义(t＝6.968,P<0.05);其他时间点两组白细胞数量差异无统计学意义。移植后两组受鼠各时间点血红蛋白检测结果差异均无统计学意义。移植后＋7 d实验组和对照组血小板数量分别为(125±40)×10⁹/L和(64±15)×10⁹/L,移植后＋14 d分别为(282±47)×10⁹/L和(163±41)×10⁹/L,差异均有统计学意义(t＝6.366和8.093,P均<0.05);其他时间点两组血小板数量差异无统计学意义。 结论使用脐血细胞作为第三方细胞辅助输注后,可促进单倍型造血干细胞移植受鼠早期白细胞和血小板较快恢复。     

Functional recovery after human umbilical cord blood cells transplantation with brain-derived neutrophic factor into the spinal cord injured rat

Summary There have been many efforts to recover neuronal function from spinal cord injuries, but there are some limitations in the treatment of spinal cord injuries.The neural stem cell has been noted for its pluripotency to differentiate into various neural cell types. The human umbilical cord blood cells (HUCBs) are more pluripotent and genetically flexible than bone marrow neural stem cells. The HUCBs could be more frequently used for spinal cord injury treatment in the future.Moderate degree spinal cord injured rats were classified into 3 subgroups, group A: media was injected into the cord injury site, group B: HUCBs were transplanted into the cord injury site, and group C: HUCBs with BDNF (Brain-derived neutrophic factor) were transplanted into the cord injury site. We checked the BBB scores to evaluate the functional recovery in each group at 8 weeks after transplantation. We then, finally checked the neural cell differentiation with double immunofluorescence staining, and we also analyzed the axonal regeneration with retrograde labelling of brain stem neurons by using fluorogold. The HUCBs transplanted group improved, more than the control group at every week after transplantation, and also, the BDNF enabled an improvement of the BBB locomotion scores since the 1 week after its application (P<0.05). 8 weeks after transplantation, the HUCBs with BDNF transplanted group had more greatly improved BBB scores, than the other groups (P<0.001). The transplanted HUCBs were differentiated into various neural cells, which were confirmed by double immunoflorescence staining of BrdU and GFAP & MAP-2 staining. The HUCBs and BDNF each have individual positive effects on axonal regeneration. The HUCBs can differentiate into neural cells and induce motor function improvement in the cord injured rat models. Especially, the BDNF has effectiveness for neurological function improvement due to axonal regeneration in the early cord injury stage. Thus the HUCBs and BDNF have recovery effects of a moderate degree for cord injured rats.     

The effect of cryopreservation on clonogenic capacity and in vitro expansion potential of umbilical cord blood progenitor cells

BACKGROUND: Umbilical cord blood progenitor cells have been demonstrated to possess significant advantages over bone marrow in terms of proliferative capacity and immunologic reactivity. But the low number of hematopoeitic stem cells (HSC) is the most important limitation of its use. The ex vivo expansion of cord blood progenitor cells is the current strategy to overcome this problem. Furthermore, among the factors that enable successful cord blood transplantation is the ability to store and subsequently recover a sufficient number of viable cells. Since it would be costly to expand umbilical cord blood (UCB) progenitor cells, it is important to determine the feasibility and reproducibility of progenitor cell expansion after cryopreservation. We evaluated whether cryopreservation procedures might impair the clonogenic capacity and in vitro expansion of UCB. MATERIALS AND METHODS: We evaluated the cell viability, clonogenic capacity, CD34+38- content and in vitro expansion potential of progenitor cells from UCB (n = 10) separated mononuclear cells (MNC), before and after 1 month of cryopreservation by programmed rate freezing. RESULTS: Although cell viability decreased after cryopreservation (P < .05), there was no significant difference in CD34+ or CD34+38- absolute count, colonogenic capacity and in vitro expansion potential of cord blood progenitor cells (P > .05). CONCLUSIONS: Since the survival of CD34+ cells was greater than other elements, CD34+ cells seem more tolerant to cryopreservation than the other nucleated populations. Moreover in vitro expansion of UCB progenitor cells may be obtained following cryopreservation. Our results suggest that cryopreservation procedures do not impair the clonogenic capacity and in vitro expansion potential of cord blood stem/progenitor cells.     

Analysis of HLA haplotype and clinical factors during hematopoietic stem cell transplantation

BackgroundThe human leukocyte antigen (HLA) haplotype of the recipient in hematopoietic stem cell transplantation (HSCT) is a key factor in its success or failure. We analyzed the relationship between HLA haplotype frequency and associated clinical factors in HSCT patients.MethodsPatients who underwent allogeneic HSCT between 2000 and 2019 at our institution were enrolled in this study. The HSCT composition was 77 bone marrow transplantations (BMT), 38 peripheral blood stem cell transplantations (PBSCT), and 36 cord blood transplantations (CBT). Patients were classified into three groups according to their donor HLA haplotype frequency in the Japan Population: group A, top 1–10 haplotypes; group B, top 11–100 haplotypes; and group C, haplotype 101-. We then compared various items including clinical biomarkers with the HLA haplotype frequency.ResultsA significant negative correlation was identified between older persons and length of survival. There are also significant correlations between survival and levels of immunoglobulin G, D-dimer, and C-reactive protein, as well as the platelet-large cell ratio before transplantation. A total of 96, 30, and 25 patients were classified into groups A, B, and C, respectively. The HSCT match rate was significantly higher in group A patients than in those of groups B and C. In contrast, the death rate, D-dimer level, and length of time for engraftment were significantly higher in group B and C patients than in those of group A.ConclusionAn assessment of transplant-related complications is important in improving the performance of HSCT. The present data suggest that a special therapeutic strategy is necessary for HSCT using low-frequency HLA haplotypes.     

Cultured human epithelium: human umbilical cord blood stem cells differentiate into keratinocytes under in vitro conditions

BACKGROUND: Stem cells have the capacity to renew or to give rise to a specialized cell types. Human umbilical cord blood (HUCB) has been explored as an alternative source of stem cells. However, its potential to differentiate into cells of other tissues is still under discussion. The aim of our study was to evaluate if HUCB stem cells could differentiate into epithelial cells under in vitro conditions. METHODS: Human keratinocytes derived from adult female skin donors, were isolated and cultured on fibrin glue/fibroblast gels-control group. In the umbilical cord blood cell group, male umbilical cord blood cells were added at a 1:10 ratio to keratinocytes and co-cultured on the fibrin glue/fibroblasts gel. After 15 days of culture, the sheets were analyzed by use of histochemistry and FISH. DNA was extracted and evaluated by use of polymerase chain reaction (PCR) for detection of Y-chromosome-specific sequences. RESULTS: In both groups a regular epithelial sheet consisting of three to four layers of cells was formed. Using PCR and FISH, in the umbilical cord blood cell group the presence of Y-chromosome-specific sequences in the cultured keratinocytes could be detected. In the control group, no Y-chromosome-specific sequences could be detected. CONCLUSION: Our findings indicate that umbilical cord blood stem cells differentiate into epithelial cells under in vitro conditions and thereby, might serve as a starting material for isolation and expansion of cells for transplantation in patients with large skin defects.     

脐带间充质干细胞分化为内皮细胞促进血管新生

目的 探讨脐带间充质干细胞能否在体内外分化为内皮细胞,参与血管新生.方法 体外实验采用内皮细胞生长因子和碱性成纤维细胞生长因子对脐带间充质于细胞进行诱导,观察其形态变化.体内实验将脐带间充质干细胞移植到小鼠后肢缺血模型中,采用免疫组织化学鉴定细胞在体内的迁移和分化,激光多普勒血流成像仪鉴定缺血局部血流恢复情况.结果 在体外脐带间充质干细胞能够形成血管网样结构.在体内脐带间充质干细胞能够分化为内皮细胞,表达CD31抗体,参与实验组的动物血管重建.与小鼠的血管网络发生整合,实验组的动物后肢血流灌注明显好于对照组.结论 脐带间充质干细胞能够分化为内皮细胞,参与血管新生,为治疗性血管新生提供新的细胞选择.     

Loss of mismatched HLA in acute myeloid leukemia relapse after haploidentical peripheral blood stem cell transplantation combined with unrelated cord blood: A case report

Mismatched human leukocyte antigen (HLA) loss is an essential mechanism involved in immune escape and recurrence in acute leukemia after haploidentical transplantation. Patients relapsing after transplantation with HLA loss have a poor prognosis, and are less likely to benefit from donor lymphocyte infusion (DLI) from the original donor. Here, we report a patient with high-risk acute myeloid leukemia who relapsed within six months after haploidentical peripheral blood stem cell transplantation (PBSCT) combined with unrelated umbilical cord blood (UCB) with a session of prophylactic DLI. This patient achieved transient remission after subsequent Interferon-α-1b treatment for two weeks but experienced a second relapse within one month. Genomic analysis by real-time PCR assay revealed that this patient had a loss of an entire mismatched HLA haplotype that was derived from her haploidentical donor. Haploidentical peripheral blood stem cell transplantation with prophylactic DLI might be a triggering event for HLA loss relapse after haploidentical transplantation combined with UCB. HLA loss should be considered in patients with post-HSCT relapse, especially in haploidentical transplantation.