单倍体造血干细胞移植治疗儿童重型β-地中海贫血

郝文革, 孙新, 刘莎, 赵喆, 陈展曦

中国当代儿科杂志 ›› 2009, Vol. 11 ›› Issue (07) : 546-548.

PDF(1029 KB)
PDF(1029 KB)
中国当代儿科杂志 ›› 2009, Vol. 11 ›› Issue (07) : 546-548.
论著·临床研究

单倍体造血干细胞移植治疗儿童重型β-地中海贫血

  • 郝文革,孙新,刘莎,赵喆,陈展曦
作者信息 +

Haploidentical hematopoietic stem cell transplantation for beta-thalassemia major in children

  • HAO Wen-Ge, SUN Xin, LIU Sha, ZHAO Zhe, CHEN Zhan-Xi.
Author information +
文章历史 +

摘要

目的:目前仅有30%左右的重型β-地中海贫血患者能找到HLA全相合的同胞供者,使造血干细胞移植治疗该病受到限制。该研究通过探讨单倍体造血干细胞移植治疗儿童重型β-地中海贫血的疗效,希望能够拓展供者源。方法:采用单倍体脐血或骨髓对10例重型β-地中海贫血患儿进行11例次移植。使用以羟基脲、氟达拉滨、白消安、环磷酰胺、抗胸腺细胞球蛋白为基础的预处理方案。结果:6例患者获长期稳定植入并脱离红细胞输注;2例短暂植入后排斥,其中1例恢复地中海贫血状态,另1例在移植早期死亡;1例行2次移植均未植入并出现移植后再障;1例未植入,出现再障,1年后恢复地中海贫血状态。8例植入者均发生急性移植物抗宿主病,仅1例发展为皮肤局限性慢性移植物抗宿主病。随访57.1(2.5~85.1)月,总体生存率90%,无病生存率为60%。结论:单倍体造血干细胞移植治疗儿童重型β-地中海贫血能长期重建造血,在无HLA相合同胞供体时,可以作为造血干细胞移植治疗的一种选择。[中国当代儿科杂志,2009,11(7):546-548]

Abstract

OBJECTIVE: Hematopoietic stem cell transplantation is currently a unique curative therapy for beta-thalassemia major. However, only 30% of patients have HLA-identical siblings to serve as donors. This study investigated the feasibility of hematopoietic stem cell transplantation from HLA mismatched related donors for beta-thalassemia major in children. METHODS: Between November 2001 and November 2007, 10 patients with beta-thalassemia major at median ages of 4.4 years (range:1.6-9.4 years) received 11 transplantations from their haploidentical donors, either HLA mismatched sibling umbilical cord bloods (n=6) or parents marrows (n=4) or sibling marrow (n=1). The conditioning regiment included fludarabine (100 mg/m2), busulfan (16 mg/kg), cyclophosphamide (200 mg/kg) and antithymocyte globulin. RESULTS: Of the 10 patients, 6 (60%) had sustained engraftment and red blood cell transfusion independence; 2 patients showed transient engraftment but rejected the graft quickly; 1 patients had no evidence of engraftment and developed aplastic anemia; 1 patient who received two transplantations had no evidence of engraftment and developed persistent aplastic anemia. All eight engrafted patients showed grade I to III acute graft-versus-host disease (GVHD), and only one developed limited skin chronic GVHD. The probability of overall and disease-free survival was 90% and 60%, respectively, with a median follow-up duration of 57.1 months (range:2.5 to 85.1 months). CONCLUSIONS: Haploidentical stem cell transplantation is an alternative option for children with beta-thalassemia major, particularly when a matched sibling donor is not available.[Chin J Contemp Pediatr, 2009, 11 (7):546-548]

关键词

β-地中海贫血;造血干细胞移植;单倍体;儿童

Key words

Beta-thalassemia / Hematopoietic stem cell transplantation / Haploid / Child

引用本文

导出引用
郝文革, 孙新, 刘莎, 赵喆, 陈展曦. 单倍体造血干细胞移植治疗儿童重型β-地中海贫血[J]. 中国当代儿科杂志. 2009, 11(07): 546-548
HAO Wen-Ge, SUN Xin, LIU Sha, ZHAO Zhe, CHEN Zhan-Xi. Haploidentical hematopoietic stem cell transplantation for beta-thalassemia major in children[J]. Chinese Journal of Contemporary Pediatrics. 2009, 11(07): 546-548
中图分类号: R566.6+1   

参考文献

[1]Gaziev J, Lucarelli G. Stem cell transplantation for thalassaemia[J]. Reprod Biomed Online, 2005, 10(1):111-115.
[2]La Nasa G, Argiolu F, Giardini C, Pession A, Fagioli F, Caocci G, et al. Unrelated bone marrow transplantation for beta-thalassemia patients:The experience of the Italian Bone Marrow Group.[J] Ann N Y Acad Sci, 2005, 1054:186-195.
[3]Walters MC, Sullivan KM, O′Reilly RJ, Boulad F, Brockstein J, Blume K,et al. Bone marrow transplantation for thalassemia. The USA experience[J]. Am J Pediatr Hematol Oncol, 1994, 16(1):11-17.
[4]Gaziev D, Galimberti M, Lucarelli G, Polchi P, Giardini C, Angelucci E, et al. Bone marrow transplantation from alternative donors for thalassemia:HLA-phenotypically identical relative and HLA-nonidentical sibling or parent transplants[J]. Bone Marrow Transplant, 2000, 25(8):815-821.
[5]Angelucci E, Baronciani D. Allogeneic stem cell transplantation for thalassemia major[J]. Haematologica, 2008, 93(12):1780-1784.
[6]Sodani P, Gaziev D, Polchi P, Erer B, Giardini C, Angelucci E, et al. New approach for bone marrow transplantation in patients with class 3 thalassemia aged younger than 17 years[J]. Blood, 2004, 104(4):1201-1203.


PDF(1029 KB)

Accesses

Citation

Detail

段落导航
相关文章

/