摘要
Abstract
Objective To explore the therapeutic effect of hematopoietic stem cell transplantation for treatment of EBV-associated T/Natural Killer-cell Lymphoproliferative disorder in children. Methods A 13.5-year old boy .diagnosed with EBV-associated T/natural killer-cell lymphoproliferative disorder (EBV-T/NK-LPD) , received HLA-matched sibling PBSCT from his younger sister, as his disease was persistent after treatment with anti-virus drugs, EBV-CTL,interleukin-2 and chemotherapy. The conditioning regimen was TBI/CY+VP16 (total-body irradiation, 12 Gy in 8 fractions, -8d -5d; cyclophosphamide, 60mg/kgxtwo doses, -3d ~ -2d; a single dose of etoposide, 30mg/kg, -4d). The infused PBSCs contained 6.34×107kg nucleated cells and 3.80×106/ kg CD34 positive cells. GVHD prophylaxis consisted of cyclosporine A (CsA) and a short course of methotrexate (sMTX). Results The hematologic recovery was favorable. The patient achieved neutrophil engraftment at day +16;platelet engraftment was achieved at day +37;his hemo-gram completely recovered at day +60. The patient had no severe complications, such as fatal infections, hemorrhagic cystitis, veno-occlusive disease (VOD), interstitial pneumonia (IP),eytomegalovirus (CMV) infection, et al. He developed cutaneous Grade II acute graft-versus-host disease (GVHD) at day +62. The EBV-DNA was 1.2×105 copies/ml before transplant,and changed-over to negative at day +14; after this, the EBV-DNA was monitored weekly,persistently negative. After transplantation, the patient' s jaundice disappeared, and the liver function normalized. Rechecking type-B ultrasonic on the cervix and the abdomen, there was no signs of lymphadenectasis at pars cervicalis, hepatomega- ly , or splenomegaly; the previous lymphadenectasis at porta hepatic and aside abdominal aorta disappeared. Computed tomography scan at thorax dis- played no lymphadenectasis at portopulmonary, the mediastinum was normal. Up to now, and the patient has been followed up for 18 months after transplantation, he is still in continuing complete remission. Conclusion This was the first case who was treated by hematopoietic stem cell transplantation for EBV-T/NK-LPD in Mainland China. The transplantation was successful. The patient with EBV-T/NK-LPD can reach remission by hematopoietic stem cell transplantation, and likely to be cured with this therapy.关键词
EB病毒/T/NK细胞/淋巴组织增殖性疾病/造血干细胞移植/儿童Key words
Epstein-Barr virus/T/natural killer-cell/ lymphoproliferative disorder/ hematopoietic stem cell transplantation/ children分类
医药卫生
