例儿童非亲缘脐血移植临床研究.docVIP

【摘要】 　　本研究对山东省脐血造血干细胞库2001年8月至2004年6月所提供32例儿童无血缘脐血移植（URCBT）进行回顾性分析，观察非血缘脐血造血干细胞移植(UCBT)的疗效及并发症。常规进行脐血的收集、分离、保存、检测、冻融和输注。用PCR-SSO、PCR-SSP、SBT技术检测HLA-A、B、DR。结果表明： 32例患血液系统疾病儿童，中位年龄8(2-15)岁；中位体重31.5(14-55)kg，其中急性淋巴细胞白血病(ALL)13例，均为高危型；急性髓系白血病(AML)9例，包括M1 1例，M2 4例，M4 3例，M5 1例；慢性髓系白血病(CML)2例；重型再生障碍性贫血(SAA)3例；急性混合性白血病(HAL)3例；非何杰金氏淋巴瘤2例。供受者ＨＬＡ全相合为10例，１个位点不相合为１6例，２个位点不相合为6例。供受者ＡＢＯ血型相合12例，不相合20例。输入有核细胞（ＴＮＣ）5.57（2.16-12.3）×107／kg，CD34+细胞1.78(0.85-5.92)×105/kg。采用以环磷酰胺（Cy）和全身照射（TBI）为主的Cy/TBI预处理方案４例，以白消安（Bu）和环磷酰胺（Cy）为主的Bu/Cy预处理方案２1例，其他方案预处理7例。GVHD预防采用以环孢菌素A为主的方案。结果表明： 32例患者20例（62.5％）白细胞达到植入标准，ANC≥0.5×109/L的中位时间17（9-38）天； Plt≥20×109/L 中位时间 42(18-102)天。Ⅱ-Ⅳ度和Ⅲ-Ⅳ度急性GVHD累计发生率分别为35%和15%。1年总生存率59.4%，2年总生存率40.6%。结论： HLA相合及1-2个位点不合异基因脐血造血干细胞移植是可行的，尤其在治疗儿童血液病方面具有应用前景。 【关键词】 造血干细胞移植； 非亲缘脐血移植； 恶性血液病 　　Clinical Study of Unrelated Umbilical Cord Blood Transplantation in 32 Children Patients 　　JIANG Xi-Feng，SHENG Bai-Jun Shandong Umbilical Cord Blood Bank，Jinan 250002，China 　　Abstract To evaluate the clinical efficacy of unrelated umbilical cord blood transplantation (UCBT) on the treatment of children with hematologic malignancies and nonmalignancies，between August 2001 and June 2004，32 patients were transplanted by using unrelated umbilical cord blood supplied by Shandong Umbilical Cord Blood Bank. Out of them，13 patients suffered from ALL，9 from AML，3 from AA，3 from HAL，2 from CML and 2 from NHL. The median age was 8 years (range 2-15)，the median weight was 31.5 kg (range 14-55). All patients received ablative conditioning regiment according to the disease and the disease status. Conditioning regiments Cy/TBI were used for 4 patients and Bu/Cy for 21 patients，other for 7 patients. All patients received cyclosporin A and/or methotrexate for GVHD prophylaxis. The mean number of infused nuclear cells were 5.57(2.16-12.3)×107 /kg，CD34+ cells 1.78(0.85-5.59)×105. All of UCB units were tested for HLA-A，-B，and DRB1 using low and high resolution techniques .There were HLA-match