摘要
目的:分析高龄供者非清髓性外周血造血干细胞移植治疗老年急性白血病后,采用低剂量环孢素A免疫治疗方案的疗效。方法:选择2005-11-15广州市第一人民医院收治患者1例,男,57岁,诊断为急性非淋巴细胞白血病-M5a。患者知情同意并签署知情同意书。移植前经过化疗达到完全缓解,合并2型糖尿病、肝功能不良、慢性心脏供血不足。供者为患者同胞姐姐,64岁,HLA全相合,血型相同。干预措施:①预处理用药包括氟达拉滨、马利兰针剂和环磷酰胺。于移植前第4～9天氟达拉滨30mg/(m2.d);移植前第3,4天马利兰针0.8mg/kg,Q6h;移植前第1,2天环磷酰胺60mg/(kg.d)。②移植物抗宿主病预防用环孢素A和氨甲蝶呤,形成供者嵌合体后,采用低剂量环孢素A。③移植后并发症防治和支持治疗:更昔洛韦防治巨细胞病毒感染、前列腺素E1防治肝静脉闭塞病、移植后1d予粒细胞集落刺激因子5μg/(kg.d),Hb<70g/L和PLT<20×109L-1时输注红细胞和血小板。④供者采用粒细胞集落刺激因子动员,150μg/d,皮下注射,12h1次,连用5d,第4,5天采集外周血造血干细胞,于第5天一同输注给患者。结果:①移植后患者造血及免疫重建情况:移植后早期获得造血重建,20d时中性粒细胞>0.5×109L-1,18d时血小板>20×109L-1。自然杀伤细胞、CD3+T淋巴细胞和CD3+CD8+数恢复、CD19+B淋巴细胞和CD3+CD4+分别在移植后2,6,14个月恢复。②植入证据:移植后4周,经过DNA短串联重复序列多态性和XX/XY染色体的荧光原位杂交分析证明为供者型完全嵌合体。③移植后并发症:移植过程顺利,无严重感染,未出现急性移植物抗宿主病。移植后112d,出现腹泻、四肢和面部出现红色斑丘疹,伴有感觉功能异常,移植后6个月出现中耳积液、突发性耳聋,经过环孢素A剂量治疗控制至12个月停药。随访14个月,生活正常。结论:采用以氟达拉滨为基础的非清髓性、高龄同胞供者外
AIM： To analyze the curative effectiveness of low-dose ciclosporin A （CsA） after peripheral blood stem cell transplantation following nonmyeioablative conditioning regimen in elderly patients with acute leukemia. METHODS： A fifty-seven year-old patient,, who were diagnosed as having acute nonlymphocytic leukemia M5a, were enrolled from Guangzhou Municipal First People＇s Hospital on November 15^th, 2005. The patient knew the fact and signed the informed consent, The patient achieved complete remission by chemotherapy before transplantation, The patient complicated type 2-diabetes mellitus, dysfunction of liver and chronic heart ischemia. The patient＇s elder sister was a donor aged 64 years, with the same HLA and blood type, Interventional measures included （1）The transplantation pre-treatment drugs contained fludarabine, busufanum （BU） injection and cyclophosphamide （CY）. The drug was give in order, which was fludarabine 30 mg/m^2 per day for six days from days 9 to 4 before transplantation, busufanum （BU） injection 0.8 mg/kg, Q6h for two days, at days 4 and 3 before transplantation, cyciophosphamide （CY） 60 mg/kg per day for two days, at days 2 and 1 before transplantation. （2）CsA and methotrexate （MTX） ware used for graft-versus host disease （GVHD） prophylaxis, Low-dosage CsA was adopted after forming chimera, （3）The prophylaxis and support therapy of complications after transplantation： Ganciciovir for cytomegalovirus infection, prostagiendin E1 for veno-occlusive disease （VOD）, granuiocyte colony-stimulating factor （G-CSF） 5 μg/kg per day was used 1 day after transplantation. Red cell and pieteiet were infused when Hb below 70 g/L and plateiet below 20×10^9 L^-1. （4）G-CSF of donor was selected subcutaneously for mobilization, 150 μg/d, once 12 hours, for 5 days, At days 4 and 5 peripheral blood stem cell（PBSC）of donor was harvested, and was infused for patient at day 5, RESULTS： （1）hemopoiesis and immunologic reconstitution of patient a
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第20期4041-4043,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
