含高剂量CD34^＋细胞的非血缘脐血移植治疗AML/MDS后原发植入失败

目的分析含高剂量CD34^＋细胞的非血缘脐血移植治疗急性粒细胞白血病合并骨髓增生综合征（AML/MDS）后发生原发植入失败的原因。方法 1例4岁女孩在四川大学华西第二医院儿科血液肿瘤科被诊断为AML/MDS。患儿经诱导及巩固治疗获完全缓解后,行无血缘人类白细胞抗原（HLA）部分不相合脐血移植。观察患儿术后造血重建及移植相关并发症情况。结果患儿术后发生原发植入失败,再次进行血缘间的半相合造血干细胞移植,期间患多药耐药鲍曼不动杆菌败血症,于第2次移植后7 d死于呼吸衰竭。结论含高剂量CD34^＋细胞脐血造血干细胞并不能抵消HLA配型不合的缺陷。患儿原发植入失败可能与患儿移植前存在长期血小板输注无效及潜在免疫异常,尤其是移植前产生抗-HLA供者特异性抗体有关。

Primary graft failure following unrelated cord blood transplantation with high-dose of CD34 + cells in the treatment of AML/MDS

Objective To analysis the cause of primary graft failure of unrelated cord blood transplantation with high-dose of CD34 ^＋ cells in treatment of acute myelocytic leukemia （AML） /myelodysplastic syndrome （MDS）.Methods A 4-year-old girl was diagnosed AML/MDS at the Department of Pediatric Hematology and Oncology of West China Second University Hospital of Sichuan University. She presented completely remission after induction and consolidation chemotherapy.She received unrelated partially human leukocyte antigen （HLA）-mismatched cord blood transplantation.We investigated the treatment outcomes of UCBT and associated complications.Results The patient suffered primary graft failure and then received secondary haploidentical hematopoietic stem cell transplantation （HSCT）from her mother.However,she suffered fatal multiresistant Acinetobacter spp septicemia.She died due to respiratory failure on 7 d after the second transplantation.Conclusions In this case,hematopoietic stem cells with high dose of CD34^ ＋ cells could not overcome the risk of primary graft failure and HLA disparity.The patient＇s primary graft failure was associated with platelet transfusion refractoriness and potent immunologic dysfunction,especially the anti-HLA donor specific antibodies before unrelated cord blood transplantation.