HLA相合同胞脐血移植成功治疗一例成人慢性髓系白血病

目的研究脐血移植(CBT)治疗成人恶性血液病的可行性,观察长期造血重建和移植相关并发症的发生.方法 1例18岁体重75 kg的慢性髓系白血病慢性期(CML-CP)患者在用改良的马利兰、环磷酰胺(Bu/CTX)方案预处理后给予HLA相合同胞CBT.输入有核细胞数1.73×107/kg,CD34+细胞为2.7×105/kg.移植物抗宿主病(GVHD)预防方案选用环孢菌素A(CsA)加甲泼尼龙.结果移植后第18天中性粒细胞计数>0.5×109/L,移植后36天血小板计数>50×109/L.CBT后共给予7次血小板输注.移植后80天DNA位点检测示已全部转为供者型.移植后90天后出现严重黄疸,诊断为肝脏急性GVHD合并巨细胞病毒感染,通过加用免疫抑制剂和抗病毒药物治疗,同时辅以血浆交换和人工肝体外胆红素吸附,并发症得到控制.随访24个月,患者一般情况良好,肝功能基本正常,骨髓细胞Ph染色体和bcr/abl基因持续阴性.结论本例为国内首例应用异基因CBT成功治疗成人白血病,表明异基因CBT应用于成人血液病的治疗是可行的.

Successful engraftment of HLA-identical sibling cord blood transplantation in an adult with chronic myelogenous leukemia

OBJECTIVE: To explore the feasibility of cord blood transplantation (CBT) for the treatment of adult hematological malignancies and its long-term hematopoiesis reconstitution and transplantation-related complications. METHODS: An 18 years old patient (body weight 75 kg) with chronic myelogenous leukemia in first chronic phase received HLA-identical sibling CBT after conditioning with modified busulfan/cyclophosphamide (Bu/CTX) regimen. The transplanted number of nucleated cells was 1.73 x 10(7)/kg of body weight, and that of CD34+ cells 2. 7 x 10(5)/kg. Cyclosporin A and methylprednisolone were given as prophylaxis against graft versus-host disease (GVHD). RESULTS: The neutrophil count rose to above 0.5 x 10(9)/L on day 18 and platelet count exceeded 50 x 10(9)/L on day 36. Gene analysis showed that bone marrow cells had completely changed to donor's type on day 80. The patient was diagnosed with grade IV acute hepatic GVHD complicated with CMV infection because of severe jaundice on day 90. After the administration of additional immunosuppressive agents, antiviral agents, plasma exchange and in vitro billirubin adsorption, the complications were well controlled. In the follow-up of 24 months', the patient's general condition is good without obvious hepatic dysfunction and Ph chromosome and bcr/abl fusion gene of bone marrow cells were persistently negative. CONCLUSION: It is the first case reported in China that adult patient with leukemia has been successfully treated by allogeneic CBT, and this indicates that CBT is feasible in the treatment of adult patient with leukemia.