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背景:目前部分国外报道显示,自体及全相合造血干细胞移植联合化疗用于转移髓母细胞瘤有一定疗效,可延长患者生存期。但尚未见HLA单倍体相合移植治疗髓母细胞瘤的报道。目的:首次报道应用单倍体相合造血干细胞移植治疗髓母细胞瘤。方法:对晚期骨转移的髓母细胞瘤患儿进行连续6次无关供者淋巴细胞输注联合低剂量化疗,3次单倍体相合骨髓移植治疗。结果与结论:造血干细胞移植后患儿出现皮疹,伴发热,腹泻,为黄褐色水样便,考虑为移植物抗宿主病,以甲强龙冲击治疗并用丙种球蛋白增强免疫力,吗替麦考酚酯、他克莫司抗排斥及口服激素、抗CD25单抗、抗肿瘤坏死因子,并纠酸、维持水电平衡、支持营养等治疗好转出院,后因颅内复发死亡。异基因淋巴细胞输注可杀伤肿瘤细胞,改善患者生存质量,但对于高肿瘤负荷的患者,效果有限,如考虑进行异基因干细胞移植,应注意免疫抑制剂(如CD25单抗和肿瘤坏死因子a抑制剂)的及时应用。
Background: At present, some foreign reports show that autologous and all-matched hematopoietic stem cell transplantation combined with chemotherapy for the metastasis of medulloblastoma have a certain effect, which can prolong the survival of patients. However, no haploidentical HLA haploidentical transplantation for medulloblastoma has been reported. Objective: The first report of haploidentical hematopoietic stem cell transplantation for the treatment of medulloblastoma. Methods: Six patients with medulloblastoma with advanced bone metastases were treated with 6 consecutive unreleased donor lymphocyte infusions combined with low-dose chemotherapy and 3 haploidentical bone marrow transplantation. RESULTS AND CONCLUSION: Children with rash, fever and diarrhea after hematopoietic stem cell transplantation were considered watery brown stains. Considering graft-versus-host disease, treatment with methylprednisolone and immune globulin were used to enhance immunity. Coca-Pester, anti-rejection of tacrolimus and oral hormones, anti-CD25 monoclonal antibody, anti-tumor necrosis factor, and correct acid and water to maintain balance, nutrition and other treatments improved discharge, died of intracranial recurrence. Allogeneic lymphocyte infusion can kill tumor cells and improve the quality of life of patients, but for patients with high tumor burden, the effect is limited. Considering immunosuppressive agents such as CD25 monoclonal antibody and tumor necrosis factor a Inhibitor) timely application.