Synegenic Peripheral Blood Stem Cell Transplantation for Aplastic Anemia
|Keywords||Hematopoietic stem cell transplantation Anemia Aplastic Twin|
We implemented two cases of aplastic anemia patients syngeneic peripheral blood hematopoietic stem cell transplantation in the treatment of one case of early implant success occurred late graft rejection, another example of stability. To further explore the aplastic anemia causes, to study the mechanisms of long-term engraftment of hematopoietic stem cell transplantation, a more systematic study of these two cases the outer periphery of syngeneic hematopoietic stem cell transplantation. Hematopoietic stem cell transplantation is one of the primary means of cure aplastic anemia. Peripheral blood stem cell transplant to go through the following stages: peripheral blood hematopoietic stem cell mobilization, collection, patient pretreatment, infusion of stem cells and the prevention and treatment of various complications links. Two patients for caught Department of monozygotic twins, HLA typing and DNA analysis confirmed both for the same gene. Donor first subcutaneous injection the G-CSF300μg daily twice, peripheral blood stem cell mobilization, donor mobilization after 5 days and 6 days Application blood cell separator machine twice were extracted peripheral mononuclear cells 3.13 × 10 ~ 8/kg, CD34 positive cells were approximately 3.13 × 10 ~ 6/kg; the donor 2 collected in the first five days after the mobilization of peripheral blood mononuclear cells 8.80 × 10 8/kg. The two cases are at -4, -3, -2 days of cyclophosphamide 60mg/kg/d pretreatment, 0 days for hematopoietic stem cell infusion. After transplantation, two cases of leukocyte reduced to 0.2x10 9 / L, 0.3 × 10 9 / L time is seven days, six days. 14 days Example 1 neutrophils, hemoglobin and platelet were 1.0x10 9 / L, 67g / L, and 52 × 10 9 / L Example 2 neutrophils, hemoglobin and platelet were 1.2 × 10 - 9 / L, 76.5g / L and 59 × 10 9 / L, bone marrow examination proliferation of bone marrow like. 28 days Example 1 neutrophils, hemoglobin and platelet were 2.3 × 10 9 / L, 10 to 6g / L and 152 × 10 9 / L, respectively Example 2 neutrophils, hemoglobin and platelet 2.5 × 10 9 / L, 115g / L and 259 × 10 9 / L, bone marrow examination proliferation of bone marrow like. For four consecutive months to check blood, white blood cells, hemoglobin and platelets were within the normal range. Example 1 at 4 months after transplantation, delayed graft rejection, patient peripheral blood, bone marrow cytology back down to pre-transplant levels, Example 2 has a stable condition. The analysis of Example 1 This delayed graft rejection may be related to the following factors: 1. Transplant forecourt massive transfusion without the leukocyte filter out or irradiation; 2. Pretreatment program; 3. Patients with primary gynecological tumors. Aplastic anemia patients for hematopoietic stem cell transplantation, the key to success is to a large extent depends on graft rejection and the incidence of acute GVHD. Syngeneic hematopoietic stem cell transplantation success lies in whether the occurrence of graft rejection. Therefore, the requirements of reasonable transfusion before transplantation, the white blood cells of patients sensitized to remove blood products, through in vitro irradiation ways to reduce immunogenicity of blood products;, and patient Chinese abstracts used prior to bone marrow transplantation with strong immune suppression pretreatment programs to reduce the incidence of graft rejection. As more and more patients are able to obtain long-term survival, we must consider the conditioning regimen and post-transplant immune suppression caused by long-term sequelae, especially secondary tumors. Compared with CY / ATG program, irradiation-based program caused secondary tumors and slow the growth and development of children, resulting in a significant increase in the likelihood of infertility. Therefore, CY / ATG conditioning regimen program is ideal aplastic anemia. Instance with allogeneic hematopoietic stem cell transplantation in the treatment of aplastic anemia following conclusions: 1, in the pathogenesis of aplastic anemia not only factors of hematopoietic stem cell defects, immune mechanisms is an important cause of its onset. 2, hematopoietic stem cell transplantation is the primary means to cure severe aplastic anemia with hematopoietic stem cell transplantation for chronic aplastic anemia. Peripheral blood stem cell transplantation has a simple, safe and fast hematopoietic recovery characteristics worthy of promotion. Reasonable transfusion and appropriate pretreatment before transplantation of hematopoietic stem cell transplantation key to success.