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目的分析含高剂量CD34+细胞的非血缘脐血移植治疗急性粒细胞白血病合并骨髓增生综合征(AML/MDS)后发生原发植入失败的原因。方法 1例4岁女孩在四川大学华西第二医院儿科血液肿瘤科被诊断为AML/MDS。患儿经诱导及巩固治疗获完全缓解后,行无血缘人类白细胞抗原(HLA)部分不相合脐血移植。观察患儿术后造血重建及移植相关并发症情况。结果患儿术后发生原发植入失败,再次进行血缘间的半相合造血干细胞移植,期间患多药耐药鲍曼不动杆菌败血症,于第2次移植后7 d死于呼吸衰竭。结论含高剂量CD34+细胞脐血造血干细胞并不能抵消HLA配型不合的缺陷。患儿原发植入失败可能与患儿移植前存在长期血小板输注无效及潜在免疫异常,尤其是移植前产生抗-HLA供者特异性抗体有关。
Objective To analyze the reasons for the failure of primary implantation after non-blood cord blood transplantation with high-dose CD34 + cells in patients with acute myeloid leukemia and myelodysplastic syndrome (AML / MDS). Methods A 4-year-old girl was diagnosed as AML / MDS in Department of Hematology and Oncology, Huaxi No.2 Hospital, Sichuan University. After induction and consolidation in children with complete remission, the line of unrelated HLA leukemia cell transplantation does not match umbilical cord blood transplantation. Observe the postoperative hematopoietic reconstitution and transplantation-related complications in children. Results The primary implantation failure occurred in children. Semi-matched hematopoietic stem cell transplantation was carried out in children with multidrug-resistant Acinetobacter baumannii sepsis and died of respiratory failure at 7 days after the second transplantation. Conclusion Cord blood hematopoietic stem cells containing high dose of CD34 + cells do not counteract the defect of HLA matching. Failure of primary implantation in children may be associated with ineffective long-term platelet transfusion and potential immunologic anomalies prior to transplantation, particularly in the generation of anti-HLA donor-specific antibodies prior to transplantation.