单倍体造血干细胞移植治疗急性淋巴细胞白血病植入失败的二次移植策略

张競文; 孙燕玲; 李旭东

doi:10.3969/j.issn.1674-7445.2018.06.008

单倍体造血干细胞移植治疗急性淋巴细胞白血病植入失败的二次移植策略

doi: 10.3969/j.issn.1674-7445.2018.06.008

510630 广州，中山大学附属第三医院血液内科中山大学血液病研究所

基金项目:

广东省医学科学技术研究基金项目 A2018253

中山大学附属第三医院临床研究计划 QHJH201806

详细信息

作者简介:
张競文，女，1982年生，博士，主治医师，研究方向为血液病学，Email：linlin_jw@163.com

通讯作者:
李旭东，女，1974年生，硕士，副主任医师，研究方向为造血干细胞移植，Email：13631359815@139.com

中图分类号: R617, R551
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出版历程
- 收稿日期: 2018-08-23
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-11-15

Secondary transplantation strategy for graft failure of haploidentical hematopoietic stem cell transplantation for acute lymphocytic leukemia

Department of Hematology, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Hemopathy of Sun Yat-sen University, Guangzhou 510630, China

More Information

Corresponding author: Li Xudong, Email:13631359815@139.com

摘要

摘要: 目的探讨急性T淋巴细胞白血病患者初次单倍体造血干细胞移植后植入失败并发生致命性并发症的二次移植策略。方法 1例男性患者诊断为急性T淋巴细胞白血病，2015年11月接受供者为其胞妹的首次单倍体造血干细胞移植后植入失败，并发生大肠杆菌败血症、血清病、肝静脉闭塞症和多器官功能衰竭。首次移植后32 d行供者为其父亲的挽救性二次单倍体造血干细胞移植，二次移植前未进行预处理化学药物治疗（化疗），采用移植后环磷酰胺（PTCy）方案为基础的移植物抗宿主病（GVHD）预防方案。结果造血干细胞移植术后12 d白细胞植入，术后67 d血小板植入。血清病、败血症及肝静脉闭塞症治愈，器官功能改善。但移植后第18个月，即2017年6月，患者死于白血病复发。结论植入失败患者二次移植前不进行预处理化疗，采用PTCy预防GVHD有望获得成功植入。
- 植入失败 /
- 单倍体造血干细胞移植 /
- 急性淋巴细胞白血病 /
- 移植物抗宿主病（GVHD） /
- 环磷酰胺 /
- 预处理方案 /
- 败血症 /
- 肝静脉闭塞症 /
- 血清病
Abstract: Objective To explore the secondary transplantation strategy for graft failure of the primary haploidentical hematopoietic stem cell transplantation (haplo-SCT) associated with fatal complications in a patient with acute T-cell lymphocytic leukemia. Methods One male patient was diagnosed with acute T-cell lymphocytic leukemia. In November 2015, he received haplo-SCT from his sister as the donor. But graft failure was developed and complicated by Escherichia coli sepsis, serum disease, hepatic venous occlusion and multiple organ failure. At 32^nd d after the first transplantation, secondary haplo-SCT from his father as the donor was performed. Prior to secondary transplantation, chemotherapy pretreatment was not conducted. Post-transplantation cyclophosphamide (PTCy)-based prevention measure against the graft-versus-host disease (GVHD) was adopted after transplantation. Results White blood cells were implanted on the 12nd d and platelet implantation was performed on the 67th d after haplo-SCT. Serum disease, septicemia and hepatic venous occlusion were cured and organ function was improved. However, the patient died from the recurrence of leukemia at 18^th months after transplantation (June 2017). Conclusions Prior to secondary haplo-SCT, PTCy prevention measures against the GVHD rather than pretreated chemotherapy probably contributes to the success of transplantation.
- Graft failure /
- Haploidentical hematopoietic stem cell transplantation /
- Acute lymphocytic leukemia /
- Graft-versus-host disease (GVHD) /
- Cyclophosphamide /
- Pre-treatment regime /
- Septicemia /
- Hepatic venous occlusion /
- Serum disease

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参考文献(15)

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