中国实用儿科杂志

中国实用儿科杂志

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母亲供髓移植治疗儿童复发非霍奇金病1例并文献复习

唐湘凤1;何岳林2;李春富2   

  1. 1海军总医院儿科(北京，100037) 2第一军医大学南方医院儿科(广州，510515)
  • 收稿日期:2005-04-11 修回日期:2005-07-20 出版日期:2005-11-25 发布日期:2005-11-25
  • 通讯作者: 唐湘凤

A report of hematopoietic stem cell transplantation from maternal donor in the treatment of a patient with nonHodgkin’s disease

Tang Xiangfeng,He Yuelin,Li Chunfu.   

  1. Paediatric Department of Navy General Hospital,Beijing 100037,China
  • Received:2005-04-11 Revised:2005-07-20 Online:2005-11-25 Published:2005-11-25

摘要： 目的 探讨母亲供髓异基因造血干细胞移植(AlloHSCT)治疗恶性复发非霍奇金淋巴瘤的疗效和供体造血干细胞来源问题。 方法 2004年1月，第一军医大学南方医院儿科与海军总医院儿科给1例8岁男性淋巴母细胞淋巴瘤(LBL)患儿移植了母亲来源的HLA不全相合、ABO血型不合的骨髓造血干细胞。预处理选用阿糖胞苷、足叶乙苷、环磷酰胺和全身照射。预防移植物抗宿主病(GVHD)采用兔抗人T淋巴细胞免疫球蛋白、环孢菌素A、甲氨蝶呤和CD25单克隆抗体。移植有核细胞数8.92×108/kg，单个核细胞数为1.89×108/kg，CD34细胞数为1.37×106/kg，CD3细胞数为32.9×107/kg。 结果 粒细胞绝对数>0.5×109/L的天数是移植后15d(+15d)，血小板>30×109/L的天数是+20d，+27d采用荧光原位杂交性染色体检测显示99%为供者型。+37d受者血型由O型转变为供者血型B型。患儿于+19d出现Ⅰ度急性GVHD，给予激素冲击后，口服小剂量维持治疗，渐消退，随访1年余，未发生慢性GVHD。 结论 母亲来源的骨髓造血干细胞移植对LBL有根治性治疗作用，而且在一定程度上解决造血干细胞来源问题。

关键词: 造血干细胞移植, 母亲, 供者, 淋巴母细胞瘤

Abstract: Abstract Objective To explore the efficacy of allogenetic hematopoietic stem cell transplantation from maternal donor in the treatment of a patient with aggressive and refgractory nonHodgkin’s disease and the problem of donor hematopoietic stem cell source. Methods A 8yearold patient with lymphoblastic lymphoma received bone marrow transplantation from HLAuncompatible maternal donor,and the blood type of ABO is uncompatible.The pretreatment regimen was Cytarabine,Etoposide,Cyclophosphamide and total body irradiation.The prophylaxis of acute graft versus host disease(GVHD) is Antithymocyte globulin(ATG),Cyclosporin,Methorexate and CD25 monoclonal antibody.The patient received 8.92×108kg-1 nuclear cell,1.89×108 kg-1 mononuclear cell,1.37×106 kg-1,CD34cell,32.9×107kg-1 CD3cell. Results The day of granulocytes exceeding 0.5×109/L and platelets exceeding 30×109/L were respectively on day 15 and 20 after transplantation,99% donors' hematopoietic stem cells were shown on the 27th day after transplantation by FISH sex chromosome analysis,and the blood type of the patient changed from O to B on the 37th day.The patient experienced gradeⅠacute GVHD which responded to steroids.Chronic GVHD was not found during the one year of followup. Conclusion The allogenetic hematopoietic stem cell transplantation from maternal donor is an effective radical cure for a patient with aggressive and regractory lymphoblastic lymphoma,and to some extent can settle the problem of donor hematopoietic stem cell source.

Key words: Lymphoblastic lymphoma , Maternal, Donor