两份脐血联合移植治疗成人慢性粒细胞性白血病一例

为了探讨两份非亲缘供者脐血联合移植治疗成人血液系恶性肿瘤患者的造血重建及移植相关性并发症 ,对 1例成人慢性粒细胞性白血病患者进行两份非亲缘供者脐血联合移植。预处理采用白消安 /环磷酰胺 (Bu/Cy)方案。移植物抗宿主病 (GVHD)的预防采用霉酚酸酯 (MMF)联合环孢霉素 (CsA)和短程氨甲喋呤 (MTX )方案。移植总单个核细胞数为 4.63× 10 7/kg ,CD3 4 + 细胞数为 8.3 4× 10 5 /kg。采用PCR法测定患者外周血细胞短串重复序列 (STR)获取植入证据。结果表明 :患者于移植后 2 3天外周血中性粒细胞绝对值 >0 .5× 10 9/L ,移植后 3 3天外周血血小板 >2 0× 10 9/L ,移植后 47天血小板 >50× 10 9/L。移植后 ,患者Ph染色体转阴性 ,bcr/abl融合基因阴性。移植后 3 1天 ,46天及 71天查外周血STR显示其中 1份脐血完全植入。患者于移植后 13天出现Ⅱ度急性GVHD ,经治疗后消失。结论 :脐血联合移植可用于成人恶性血液病的治疗 ,多份脐血联合移植可能是解决单个核细胞数偏低问题的途径之一

Treatment of One Case of Adult Chronic Myelogenous Leukemia by Two Units of Unrelated Umbilical Cord Blood Transplantation

To explore the hematopoietic reconstitution and transplantation-related complications of two units of unrelated umbilical cord blood combined transplantation for the treatment of adult hematologic malignancies, one adult patient with chronic myelogenous leukemia received two units of unrelated umbilical cord blood combined transplantation. The conditioning regimen was busulfan and cyclophosphamide (Bu-Cy). GVHD prophylaxis regimen consisted of mycophenolate mofetil (MMF), cyclosporine A (CsA) and methotrexate (MTX). The patient received total nucleated cells 4.63 x 10(7)/kg with CD34+ cells 8.34 x 10(5)/kg. Engraftment was documented by the analysis of short tandem repeat with polymerase chain reaction (STR-PCR). The results showed that the STR-PCR analysis for peripheral blood at day 31, 46 and 71 after transplantation suggested that one of two units of cord blood were completely engrafted. The ANC > 0.5 x 10(9)/L in the patient occurred at day 23, blood platelet counts > 20 x 10(9)/L at day 33 and > 50 x 10(9)/L at day 47. The Philadelphia chromosome and bcr/abl fusion gene of the patient also turned to negative after engraftment. Acute GVHD grade II occurred at day 13 and cured after treatment. It is concluded that umbilical cord blood can be used in adult hematopoietic stem cell transplantation. Two or more units umbilical cord blood combined transplantation might be the way to solve the problem of the low counts of nucleated cells when be used for adult.