【摘要】 目的　探讨无关脐血移植 (UD UCBT)治疗儿童高危急性白血病的疗效及合并症。方法　采用UD UCBT治疗儿童高危急性白血病 5例 ,其中急性淋巴细胞白血病 (ALL) 2例 ,急性混合性白血病 (HAL) 1例 ,慢性粒细胞白血病 (CML)急淋变 1例 ,非霍奇金淋巴瘤 (Ⅳ期 )第 2次完全缓解 (CR2 ) 1例。人类白细胞相关抗原(HLA) 5 / 6个位点相合 3例 ,6 / 6个位点相合 2例。输入脐血 (UCB)有核细胞数为 (4 9～ 11 78)× 10 7/kg。结果　 5例患儿中 4例获得造血重建。白细胞恢复至 1 0× 10 9/L以上所需时间为 13～ 18d ,与异基因骨髓移植无明显差别 ;但血小板恢复延迟 ,恢复至 2 0× 10 9/L以上所需时间为 4 5～ 6 0d。 4例获得造血重建患儿中 ,2例发生Ⅰ度急性移植物抗宿主病 (aGVHD) ,Ⅱ度和Ⅲ度aGVHD各 1例。aGVHD出现较早 (在脐血输注后 4～ 10d)。但增加环孢素A(CsA)剂量 ,加用甲基泼尼松龙治疗 ,aGVHD容易控制。结论　UD UCBT可有效重建造血 ,但血小板恢复延迟。严重aGVHD的发生与HLA不相合位点数目无关。在疾病的恢复稳定状态进行移植治疗 ,可望获得更好的远期疗效。更多还原

【Abstract】 Objective To evaluate the clinical efficacy and complication of unrelated donor umbilical cord blood transplantation(UD-UCBT) for children with high-risk acute leukemia.Methods Five patients with high-risk acute leukemia accepted UD-UCBT.Of them,2 cases were with acute lymphoblastic leukemia(ALL),one with hybrid acute leukemia(HAL),one with chronic myelogenous leukemia(CML→ALL) and one non-Hodgkin’s lymphoma (NHL-Ⅳ).In 5 cases who accepted UD-UCBT,2 were HLA-identical(6/6),3 were HLA-antigen mismatched(5/6).UCB NC infused was 8.43×10 7/kg (4.9×10 7～11.78×10 7/kg).Results Four were engrafted in 5 evaluated cases.The median time to reach neutrophil count(NC)≥1.0×10 9/L was 16.25 days(13～18days),and there was no significant difference between UD-UCBT and bone marrow transplantation(BMT).But the platelet recovery was delayed,the time for platelet rising up to 20×10 9/L being 51.25 days(45～60days).All of the 4 cases developed acute GVHD,only one of them was above grade Ⅲ;the developing of aGVHD was early,the median time being 6 days after UD-UCBT.Increasing CsA dosage and adding methylprednisolone can effectively control the development of aGVHD.Conclusion UD-UCBT is of value for children with high-risk acute leukemia,but the platelet recovery is delayed.aGVHD is not correlated with the number of HLA mismatches.To reduce relapse and improve the outcome,UD-UCBT is recommended for high-risk acute leukemia children in good stage of the disease.更多还原