Haploidentical cord blood transplant contaminated with maternal T cells in a patient with advanced leukaemia.
Haploidentical cord blood transplant contaminated with maternal T cells in a patient with advanced leukaemia.
复制标题
晚期白血病患者接受母体 T 细胞污染的单倍体脐带血移植。
作者：
M. Abecasis;A. Machado;G. Boavida;M. G. Silva;P. Lúcio;A. Ambrosio;M. Jorge
清髓治疗后用脐带血 (UCB) 干细胞进行淋巴造血重建可以治愈儿童白血病。对HLA 2-和3-抗原不匹配的同胞进行UCB移植的临床经验相当有限，并且没有关于此类患者接受被母体T淋巴细胞严重污染的UCB的报道。在这项研究中，我们报告了治疗一名处于急变期的慢性粒细胞白血病儿童的经验，该儿童使用来自不匹配的兄弟姐妹供体的 UCB 细胞进行移植，其中含有大量母体 T 细胞。在用 Ara-C、白消安、TBI 和环磷酰胺调理后，患者接受了 1.17 x 10(8) 有核细胞/kg。 GVHD 预防采用环孢素和抗 CD25 单克隆抗体。尽管植入有点慢，但根据细胞遗传学分析和 DNA 研究记录，植入已经完成。通过 RT-PCR 对混合 BCR/ABL 基因进行的微小残留病监测结果显示，移植后没有白血病 mRNA 的证据。急性 GVHD（仅限皮肤）在第 +14 天出现，但对低剂量类固醇迅速起反应。用于 UCB 收集的技术可能发现细胞污染。尽管存在这些潜在的缺点：晚期疾病、HLA 抗原不同的供体以及严重的母体 T 细胞污染，移植还是成功的，并且在 14 个月的随访中，孩子状况良好，没有慢性 GVHD 的证据。在这种情况下，脐带血的免疫幼稚和母体 T 细胞缺乏免疫反应性可能在该病例的结果中发挥了重要作用。
Myeloablative treatment followed by lymphohaematopoietic reconstitution with stem cells from umbilical cord blood (UCB) can cure children with leukaemia. The clinical experience of UCB transplantation with HLA 2- and 3-antigen mismatched siblings is rather limited and there are no reports of such patient being given UCB significantly contaminated with maternal T lymphocytes. In this study, we report our experience in treating a child with chronic myeloid leukaemia in blast crisis who was transplanted using UCB cells from mismatched sibling donor containing a significant number of maternal T cells. The patient received 1.17 x 10(8) nucleated cells/kg after conditioning with Ara-C, busulphan, TBI and cyclophosphamide. GVHD prophylaxis was with cyclosporine and an anti-CD25 monoclonal antibody. Although engraftment was somewhat slow it was complete as documented by cytogenetic analysis and DNA studies. Results of minimal residual disease monitoring by RT-PCR for the hybrid BCR/ABL gene showed no evidence of leukaemic mRNA post-transplant. Acute GVHD, skin only, developed on day +14 but promptly responded to low-dose steroids. The technique used for UCB collection may have cell contamination found. In spite of these potential disadvantages: advanced disease, HLA antigen disparate donor and significant maternal T cell contamination, the transplant was successful and at a follow-up of 14 months the child is well with no evidence of chronic GVHD. Immune naivety of cord blood and lack of immunological reactivity of maternal T cells in this context may have played a significant role in the outcome of this case.