| Objective To evaluate mesenchymal stem cells(MSC) with hematopoietic stem cells(HSC) from bone marrow and peripheral blood transplantation in the treatment of chronic aplastic anemia(CAA), observe the course of the hematopoitic and immune constitution as well as the occurrence of graft versus host disease(GVHD). Method A 17-year-old male patient ,has been diagnosed CAA for 8 years. Because his pathogenetic condition was bader, infused constituent blood 10 per annum, so received MSC associating with HSC of bone marrow and peripheral blood transplantation, deriving from a HLA-B,DR and blood type-mismatched sibling old sister. The patient received 1.22×105 MSCs∕㎏, 10.29×108 peripheral blood nucleated cells∕㎏, containing 8.46×108 MNCs∕㎏, 8.39×106 CD34+ cells∕㎏, as well as 750ml bone marrow , containing 2.99×108 nucleated cells∕㎏. The condition regimen was Fludarbine 50㎎·d-1(-6～-2d), ATG 750㎎·d-1(-6～-2d), Cyclophosphamide 30㎎·㎏-1·d-1(-3,-2d), CSA was given together with MMF and MTX and CD25 monoclonal antibody and MSC for prevention of GVHD. Result The recipient showed hematopoietic reconstitution when PLT was up to 20×109/L on day 13 and ANC 0.5×109/L on day 17 post transplantation. On day 18, Th cells ascended from 23.0 to 38.2, Ts cells descended from 24.2 to 13.6, Th∕Ts from 0.95 to 2.81, On day 19, IgG from 6.6 to 10.3, on day 32, NK cells from 3.40 to 16.5, indicating earlier immune reconstitution. On day 100, the myelogram started to recovery, STR signed the completed host chimera, the recipient,s blood type changed from AB to B, indicating the success of transplantation. On day 35, the patient subjected to theⅠ-GVHD, on day 48,Ⅱ-GVHD. At the last follow-up of 6 months, the patient , skin of face signed chronic GVHD ,showed normal hemogram , immune globulin is in the formal level, indicating the hematopoietisis and immune persistent reconstitution. Conclusion This is a case report of successful treatment of CAA by HLA-mismatched allogene MSC associating with HSC from peripheral blood and bone marrow transplantation... |
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