Gerritsen E J, Stam E D, Van den Berg H, Haraldsson A, Van Tol M J, Vossen J M
Department of Paediatrics, Leiden University Hospital, The Netherlands.
Bone Marrow Transplant. 1996 May;17(5):781-7.
Allogeneic BMT using a non-genotypically HLA-identical donor may be curative for children suffering from lethal haematological diseases, who lack a genotypically HLA-identical donor. Unfortunately, graft failures are often seen, especially after T cell depletion of the graft. We studied whether untimely decreased counts of leucocytes and reticulocytes in peripheral blood might predict graft failure at an early stage. Fifty-five recipients of a non-genotypically HLA-identical BM graft were included in the study; data from these children were compared with those of 77 recipients of a genotypically HLA-identical BM graft. Time-related reference values of peripheral blood leucocyte and reticulocyte counts were established in graft recipients with proven donor-origin recovery after BMT. Graft failure after nonHLA-identical BMT was observed in 16 out of 55 children (29%) and after HLA-identical BMT in one out of 77 (1.3%). With respect to early graft failure, the predictive value of granulocyte numbers falling below the lower limit of the reference values and a rapid decline of reticulocyte numbers after their appearance in peripheral blood was 100% (95% confidence intervals of 83-100% and of 80-100%, respectively). Early immunosuppressive intervention was applied in six patients and was successful in three of them.
对于患有致命血液疾病且缺乏基因分型HLA匹配供体的儿童，使用非基因分型HLA匹配供体进行异基因骨髓移植可能具有治愈效果。不幸的是，移植失败情况经常出现，尤其是在对移植物进行T细胞去除后。我们研究了外周血中白细胞和网织红细胞计数过早下降是否可能在早期预测移植失败。55名接受非基因分型HLA匹配骨髓移植的受者被纳入研究；将这些儿童的数据与77名接受基因分型HLA匹配骨髓移植的受者的数据进行比较。在骨髓移植后已证实供体来源恢复的移植受者中建立外周血白细胞和网织红细胞计数的时间相关参考值。55名儿童中有16名（29%）在接受非HLA匹配骨髓移植后出现移植失败，77名中有1名（1.3%）在接受HLA匹配骨髓移植后出现移植失败。关于早期移植失败，粒细胞数量低于参考值下限以及网织红细胞在外周血中出现后数量迅速下降的预测价值为100%（95%置信区间分别为83 - 100%和80 - 100%）。6名患者接受了早期免疫抑制干预，其中3名成功。
