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目的为扩大供者来源,探讨在子-母微量嵌合体基础上同胞间非T淋巴细胞去除(Non-TCD)HLA半相合造血干细胞移植的可行性。方法受者的原发病为慢性粒细胞白血病(CML)急性淋巴细胞病变,供者为其胞弟,供、受者HLA有3个抗原不同,经套式序列特异引物聚合酶链反应技术检测,供者微量嵌合体阳性。采用全身照射、司莫司汀、阿糖胞苷、环磷酰胺及兔源抗胸腺细胞球蛋白等对受者进行预处理;采用环孢素A、霉酚酸酯及甲氨蝶呤预防移植物抗宿主病(GVHD)。结果移植后受者的外周血中性粒细胞>0.5×109/L和血小板>20×109/L的时间分别为11、18d,骨髓检查显示增生活跃,粒细胞系、红细胞系形态和比例正常;1、2、3、6个月和1年时完全供者型嵌合>90%。术后发生Ⅱ度急性GVHD及慢性局限性GVHD,经调整免疫抑制治疗方案后缓解。受者现基本恢复正常生活。结论子-母微嵌合体阳性的HLA半相合同胞可作为Non-TCD造血干细胞移植的供者。
Objective To expand the source of donors and explore the feasibility of sibling HLA-haploidentical hematopoietic stem cell transplantation based on sub-mother microchimerism. Methods The primary disease of the recipient was chronic lymphocytic leukemia (CML) acute lymphocytic lesion. The donors were their cousins. The donors and recipients had different HLA antigens and were detected by nested sequence-specific primer polymerase chain reaction , Donor micro-chimera positive. The recipients were pretreated with systemic irradiation, simvastatin, cytarabine, cyclophosphamide and rabbit anti-thymocyte globulin. Ciclosporin A, mycophenolate mofetil and methotrexate Anti-host disease (GVHD). Results The recipients’ peripheral blood neutrophils> 0.5 × 109 / L and platelet count> 20 × 109 / L were 11 and 18 days after transplantation, respectively. The bone marrow examination showed hyperplasia, granulocyte and erythrocyte morphology and proportion were normal ; Complete donor chimerism> 90% at 1, 2, 3, 6 months and 1 year. Ⅱ degree of acute GVHD and chronic GVHD after surgery, after adjustment for immunosuppressive regimen relief. The recipient is basically back to normal life. Conclusions The HLA-haploidentical sibling positive for the daughter-mother micro-chimera can be used as donor of Non-TCD hematopoietic stem cell transplantation.