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目的评估异基因外周血造血干细胞移植治疗儿童重型再生障碍性贫血(再障)的疗效,探讨移植中合并巨细胞病毒感染治疗及其对长期造血重建的影响。方法患儿,男,12岁,供者为其胞姐,HLA配型完全相合。动员方案:G_CSF5μg/(kg·d)×6d。预处理方案:环磷酰胺(CTX)50mg/(kg·d)×4d,抗胸腺球蛋白3mg/(kg·d)×3d,氟达拉滨50mg/(kg·d)×3d。移植有核细胞数5.26×108/kg,CD34+细胞6.25×106/kg,CFU_GM10.21×105/kg。观察监测巨细胞病毒(CMV)感染,更昔洛韦(GCV)与可耐联合应用。结果移植后28d造血重建,移植后84d血型转为供者型(B型),染色体检测转为供者46XX移植后81d曾发生CMV感染,经早期、联合治疗后感染控制。未发生急、慢性移植物抗宿主病(GVHD),移植后骨髓象、血象正常。结论异基因外周造血干细胞移植可有效治疗重型再障,抗CMV感染治疗应早期、足量、联合、长期。
Objective To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation in the treatment of children with severe aplastic anemia (aplastic anemia) and to explore the effects of combined cytomegalovirus infection in transplantation on long-term hematopoietic reconstitution. Methods Children, male, 12 years old, donor for their sister cell, HLA matching completely matched. Mobilization program: G_CSF5μg / (kg · d) × 6d. Pretreatment regimen: CTX 50mg / (kg · d) × 4d, anti-thymoglobulin 3mg / (kg · d) × 3d, fludarabine 50mg / (kg · d) × 3d. Transplantation of nucleated cells 5.26 × 108 / kg, CD34 + cells 6.25 × 106 / kg, CFU_GM10.21 × 105 / kg. Observation and monitoring of cytomegalovirus (CMV) infection, ganciclovir (GCV) and tolerance can be combined. Results The hematopoietic reconstitution was performed 28 days after transplantation. The blood type was changed to donor type (type B) 84 days after transplantation. The CMV infection occurred after 81 days after the chromosome test was switched to donor 46XX. The infection was controlled after early and combined treatment. No acute and chronic graft-versus-host disease (GVHD), bone marrow after transplantation, normal blood. Conclusion Allogeneic peripheral blood stem cell transplantation can effectively treat severe aplastic anemia. The treatment of anti-CMV infection should be early, adequate, combined and long-term.