Liu Huilan, Wang Xingbing, Geng Liangquan, Tang Baolin, Tong Juan, Yao Wen, Wang Zuyi, Sun Zimin
Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, China.
Pediatr Transplant. 2010 Jun;14(4):465-70. doi: 10.1111/j.1399-3046.2009.01231.x. Epub 2009 Aug 28.
GF is a common and life-threatening complication of UCBT. Here, we report that successful second transplantation of five patients using G-CSF-mobilized maternal stem cells with non-myeloablative conditioning after GF following double UCBT. The median interval between the two transplants were 38 days. The first transplantation was administered after myeloablative conditioning for hematologic malignancies (n=3), and rabbit ATG in combination with cyclophosphamide for SAA (n=2). The second conditioning consisted of Flu and ATG-based non-myeloablative regimen. All five patients acquired quick and sustained engraftment after the second transplant. Treatment-related toxicity was minimal. Three patients developed acute GVHD (>grade II=1). Three patients developed chronic GVHD (limited=1, extensive=2). Severe infectious episodes were significant but manageable. With a median follow-up of 713 days (592-1127), all patients have currently had an event-free survival. These results indicate that a second transplant with non-myeloablative conditioning using mother as the donor for young patient after GF is feasible.
移植物失败（GF）是脐带血移植（UCBT）常见且危及生命的并发症。在此，我们报告5例患者在双重UCBT后发生GF，采用非清髓性预处理，使用粒细胞集落刺激因子（G-CSF）动员的母亲干细胞成功进行二次移植。两次移植的中位间隔时间为38天。首次移植在对血液系统恶性肿瘤进行清髓性预处理后进行（n = 3），对再生障碍性贫血（SAA）采用兔抗胸腺细胞球蛋白（ATG）联合环磷酰胺进行预处理（n = 2）。第二次预处理采用基于氟达拉滨（Flu）和ATG的非清髓性方案。所有5例患者在第二次移植后均迅速且持续植入。治疗相关毒性极小。3例患者发生急性移植物抗宿主病（GVHD，>Ⅱ级 = 1例）。3例患者发生慢性GVHD（局限性 = 1例，广泛性 = 2例）。严重感染发作虽显著但可控制。中位随访713天（592 - 1127天），目前所有患者均无事件生存。这些结果表明，对于年轻患者，在GF后以母亲为供者采用非清髓性预处理进行二次移植是可行的。
