异基因造血干细胞移植后血小板植入失败行供者外周血造血干细胞输注治疗

目的对异基因造血干细胞移植（allo—HSCT）后血小板植入失败行供者外周血造血干细胞输注（GPBSCI）治疗的安全性、有效性进行初步评估。方法采用回顾性分析方法,针对2003年4月—2006年6月于北京大学血液病研究所行allo—HSCT的15例患者行16例次GPBSCI治疗的临床资料进行分析。结果15例患者中位年龄为33岁（14～48岁）,男性9例,女性6例,均为急慢性白血病患者,接受人类白细胞抗原（HLA）配型相合或不相合骨髓或骨髓联合外周血干细胞移植,回输骨髓单个核细胞（MNC）计数平均为（4．21±1．91）×10^8／kg（1．50～7．46）×10^8／kg],回输外周血干细胞MNC计数平均为（3．27±1．40）×10^8／kg（1．13—5．90）×10^8／kg],CD34^＋计数平均为（2．13±1．69）×10^6／kg（0．24～5．67）×10^6／kg]。所有患者获得粒细胞植入,8例因原发性血小板植入失败,余8例因继发性血小板植入失败而实施GPBSCI治疗。回输中位时间为移植后＋113d（43～384d）。回输MNC计数平均为（3．09±1．54）×10^8／ks（1．35～5．99）×10^8／kg]。仅1例患者在回输后出现急性移植物抗宿主病（aGVHD）表现。3例显著有效,6例有效,1例进步,6例无效。有效率为56．3％。其中移植后100d内进行2次回输疗效更好。结论对于allo—HSCT患者血小板植入失败,采取供者外周血造血干细胞2次回输,相关不良反应小,对促进受者造血恢复能够发挥一定的疗效。

Donor peripheral stem cells infusion for the treatment of failure of platelet recovery after allogeneic hematopoietic stem cell transplantation

OBJECTIVE: To study the safety and effect of G-CSF mobilized donor hematopoietic stem cells infusion (GPBSCI) as the therapy for the failure of platelet recovery after allogeneic hematopoietic stem cell transplantation. METHODS: The clinical data of 15 patients with acute or chronic leukemia undergoing GPBSCI 16 times, 9 males and 6 females, aged 33 (14 approximately 48), were retrospectively analyzed. RESULTS: The median number of mononuclear cells (MNC) from bone marrow was (4.21 +/- 1.91) x 10(8)/kg (1.50 x 10(8)/kg approximately 7.46 x 10(8)/kg). The median number of MNCs from peripheral blood was (3.27 +/- 1.40) x 10(8)/kg (1.13 x 10(8)/kg approximately 5.90 x 10(8)/kg). The median CD34+ count was (2.13 +/- 1.69) x 10(6)/kg (0.24 x 10(6)/kg approximately 5.67 x 10(6)/kg). All the patients had achieved white cell engraftment. 8 patients with primary failure of platelet recovery and 7 patients with secondary failure of platelet recovery received donor peripheral stem cells infusion. The median day of infusion was +113 days (43 approximately 384 days). The median number of infused mononuclear cells was (3.09 +/- 1.54) x 10(8)/kg (1.35 approximately 5.99) x 10(8)/kg. Only 1 patient had transfusion related GVHD. Clinical efficacy was seen in 9 patients (56.3%). The efficacy of infusion within 100 day after transplantation was 87.50%, significantly higher than that conducted 100 days after the transplantation (25.00%, P = 0.012). CONCLUSION: With minimal side effect, GPBSCI may be an effective strategy for the therapy of failure of platelet recovery.