同一供者外周血单个核细胞输注治疗单倍相合骨髓移植后白血病复发_临床医学论文.docVIP

同一供者外周血单个核细胞输注治疗单倍相合骨髓移植后白血病复发_临床医学论文 同一供者外周血单个核细胞输注治疗单倍相合骨髓移植后白血病复发_临床医学论文 作者：薛梅 王恒湘 段连宁 刘静 阎洪敏 朱玲 丁丽 朱培瑜 【摘要】 本研究探讨同一供者外周血单个核细胞输注(DMNCI)治疗单倍相合骨髓移植后白血病复发的疗效和安全性。3例单倍相合骨髓移植后白血病复发患者接受G动员的DMNCI治疗，其中例1和例2骨髓移植前分别为ph＋急性淋巴细胞性白血病伴中枢神经系统侵犯部分缓解及慢性粒细胞性白血病急性变部分缓解，在骨髓移植后这两例均血液学复发，各接受单次DMNCI，单个核细胞剂量分别为8.25×108/kg和5.24×108/kg；CD3+细胞剂量分别为1.87×108/kg和1.14×108/kg。第3例骨髓移植前为CML急性变，治疗后并达缓解。移植后分子水平复发,接受逐渐提高单次细胞数量的分次输注，首次DMNCI剂量为2.０×107/kg，CD3+细胞剂量为1.1×107/kg。同时观察3例患者输注后白血病缓解情况及并发症。结果显示，3例患者均出现不同疗效，2例血液学复发患者骨髓均暂时缓解，但分别于DMNCI后41、48天死于严重移植物抗宿主病（GVHD）、复发及衰竭。分子水平复发患者分次接受DMNCI，输注2次后达分子水平缓解，STR测定证实为供者基因型。3例均发生急性GVHD，2例接受单次剂量输注者发生Ⅳ度以上GVHD，1例接受分次输注患者发生Ⅰ度GVHD。３例均未发生明显骨髓抑制，分子水平缓解者随访半年无病生存。结论: DMNCI可能具有抗白血病作用，可用于单倍相合骨髓移植后白血病复发的治疗，对分子水平复发者的疗效较对血液学复发者好；输注MNC为×108/kg后GVHD严重。DMNCI起始剂量×107/kg并逐渐提高单次剂量的分次输注方法更为安全。 【关键词】 白血病 Abstract This study was aimed to investigate the therapeutic effect of growth factorprimed donor peripheral mononuclear stem cell infusion (DMNCI) for patients with relapsed leukemia after haploidentical bone marrow transplantation (BMT). The donor was the same individual for both BMT and DMNCI. All the three patients described here were Philadelphia chromosome positive leukemia before haploidentical BMT; one case was newly diagnosed as acute lymhoblastic leukemia (ALL) and the others were chronic myeloid leukemia (CML). Two cases (one with ALL and one with CML) manifested with clinical relapse and the third case was in the stage of molecular relapse. The former 2 patients received a single bulk dose of DMNCI, the inoculums of which contained mononuclear cells of 8.25×108/kg or 5.24×108/kg and CD3positive cells of 1.87×108/kg or 1.14×108/kg respectively. The third case received initial dose of DMNCI which was 2.0×107/kg, and received CD3 positive cells of 1.1×107/kg. The results indicated that the different therapeutic responses were found in all three patients. Two patients with clinical relapse received temporal remission, and died of severe graft versus host disease (GVHD), relap