含高剂量CD34<sup>+</sup>细胞的非血缘脐血移植治疗AML/MDS后原发植入失败

陆晓茜; 万智; 马志贵; 高举; 朱易萍

doi:10.3969/j.issn.1674-7445.2014.06.003

含高剂量CD34⁺细胞的非血缘脐血移植治疗AML/MDS后原发植入失败

doi: 10.3969/j.issn.1674-7445.2014.06.003

610041 成都, 四川大学华西第二医院儿科血液肿瘤科

基金项目:

National Natural Science Foundation 81000215

Technology Bureau of Chengdu 11DXYB086JH-027

详细信息

通讯作者:
朱易萍, Email:yipingzhu918@qq.com

中图分类号: R617
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出版历程
- 收稿日期: 2014-09-08
- 网络出版日期: 2021-01-19
- 刊出日期: 2014-11-15

Primary graft failure following unrelated cord blood transplantation with high-dose of CD34⁺ cells in the treatment of AML/MDS

610041 Chengdu, Department of Pediatric Hematology and Oncology, West China Second University Hospital of Sichuan University

Funds:

National Natural Science Foundation 81000215

Technology Bureau of Chengdu 11DXYB086JH-027

More Information

Corresponding author: Zhu Yiping, Email:yipingzhu918@qq.com

摘要

摘要: 目的分析含高剂量CD34⁺细胞的非血缘脐血移植治疗急性粒细胞白血病合并骨髓增生综合征(AML/MDS)后发生原发植入失败的原因。方法 1例4岁女孩在四川大学华西第二医院儿科血液肿瘤科被诊断为AML/MDS。患儿经诱导及巩固治疗获完全缓解后, 行无血缘人类白细胞抗原(HLA)部分不相合脐血移植。观察患儿术后造血重建及移植相关并发症情况。结果患儿术后发生原发植入失败, 再次进行血缘间的半相合造血干细胞移植, 期间患多药耐药鲍曼不动杆菌败血症, 于第2次移植后7 d死于呼吸衰竭。结论含高剂量CD34⁺细胞脐血造血干细胞并不能抵消HLA配型不合的缺陷。患儿原发植入失败可能与患儿移植前存在长期血小板输注无效及潜在免疫异常, 尤其是移植前产生抗-HLA供者特异性抗体有关。
- 人类白细胞抗原 /
- 错配 /
- 脐血移植 /
- 造血干细胞移植 /
- 供者特异性抗体
Abstract: Objective To analysis the cause of primary graft failure of unrelated cord blood transplantation with high-dose of CD34⁺ cells in treatment of acute myelocytic leukemia(AML)/myelodysplastic syndrome (MDS[). Methods A 4-year-old girl was diagnosed AML/MDS at the Department of Pediatric Hematology and Oncology of West China Second University Hospital of Sichuan University. She presented completely remission after induction and consolidation chemotherapy. She received unrelated partially human leukocyte antigen(HLA)-mismatched cord blood transplantation. We investigated the treatment outcomes of UCBT and associated complications. Results The patient suffered primary graft failure and then received secondary haploidentical hematopoietic stem cell transplantation(HSCT) from her mother. However, she suffered fatal multiresistant Acinetobacter spp septicemia. She died due to respiratory failure on 7 d after the second transplantation. Conclusions In this case, hematopoietic stem cells with high dose of CD34⁺ cells could not overcome the risk of primary graft failure and HLA disparity. The patient's primary graft failure was associated with platelet transfusion refractoriness and potent immunologic dysfunction, especially the anti-HLA donor specific antibodies before unrelated cord blood transplantation.
- Human leukocyte antigen /
- Mismatch /
- Cord blood transplantation /
- Hematopoietic stem cell transplantation /
- Donor-specific antibody

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Table 1. The human leukocyte antigen matching of this patient and her donors

Patient and donor	Loci HLA-A	Loci HLA-B	Loci HLA-Cw	Loci HLA-DRB1
First transplantation
Patient	02/24	46/60		11/12
Cord blood	02/24	46/60		11/14
Second transplantation
Patient	0202/2424	4060/4646	0101/0310	1111/1212
Donor (her mother)	0202/0202	1562/4646	0101/0717	1212/1212

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