CAJ | 학술논문

目的大剂量化疗联合造血干细胞移植是治疗小儿晚期实体肿瘤的重要方法，目前以自体外周血干细胞为主要干细胞来源，我院收治1例神经母细胞瘤（NB）患儿，对其行自体脐带血干细胞移植，结合文献复习探讨自体脐带血来源干细胞移植治疗NB的可行性及疗效。方法移植前脐血样本经流式细胞术检测，确认无CD45-/CD56＋/CD81＋表达的神经母细胞，采用含有卡铂、依托泊苷、马法兰等联合化疗的预处理办法，自体脐带血造血干细胞输注后予阿昔洛韦及丙种球蛋白预防病毒感染，移植＋5 d予G-CSF促进粒细胞恢复。结果患儿于移植＋20 d外周血白细胞数为1.8×109/L，中性粒细胞绝对值＞0.5×109/L，移植后＋31 d血小板51×109/L，造血恢复顺利。移植后1月复查血神经元特异性烯醇化酶、24 h尿香草扁桃酸降至正常，腹部超声及全身PET-CT提示肿瘤消失。随访至4年8个月，患儿无病生存。结论自体脐带血干细胞移植治疗晚期NB安全、有效，进一步提升自体脐带血的保存价值。
목적대제양화료연합조혈간세포이식시치료소인만기실체종류적중요방법，목전이자체외주혈간세포위주요간세포래원，아원수치1례신경모세포류（NB）환인，대기행자체제대혈간세포이식，결합문헌복습탐토자체제대혈래원간세포이식치료NB적가행성급료효。방법이식전제혈양본경류식세포술검측，학인무CD45-/CD56＋/CD81＋표체적신경모세포，채용함유잡박、의탁박감、마법란등연합화료적예처리판법，자체제대혈조혈간세포수주후여아석락위급병충구단백예방병독감염，이식＋5 d여G-CSF촉진립세포회복。결과환인우이식＋20 d외주혈백세포수위1.8×109/L，중성립세포절대치＞0.5×109/L，이식후＋31 d혈소판51×109/L，조혈회복순리。이식후1월복사혈신경원특이성희순화매、24 h뇨향초편도산강지정상，복부초성급전신PET-CT제시종류소실。수방지4년8개월，환인무병생존。결론자체제대혈간세포이식치료만기NB안전、유효，진일보제승자체제대혈적보존개치。
Objective High-dose chemotherapy combined with haemopoietic stem cell transplantation,mainly meant autologous peripheral blood stem cell transplantation,is an effective way to treat pediatric advanced stage solid tumor and to improve long term survival.Our group performed a stem cell transplantation using autologous cord blood on a neuroblastoma patient,and then combined with literature review to investigate the feasibility and efficacy of this procedure on neuroblastoma. Methods Before the transplantation,autologous cord blood sample was confirmed without neuroblast which expressed CD45-/CD56+/CD81 +by flow cytometry.The preconditioning regimen of combination chemotherapy contains carboplatin,Etoposide ,Melphalan and so on.After the infusion of stem cell, acyclovir and gammaglobulin were administrated to prevent virus infection.Besides,the G-CSF is used to restore the number of neutrophil after 5 days of the transplantation.Results Twenty days after the transplantation,the number of WBC is 1 .8 ×109/L,the absolute number of neutrophil is over 0.5 × 109/L,31 days after the transplantation the number of platelets is 51 ×109/L,which meant this patient′s haematogenesis has been restored.After 1 month of the transplantation,the levels of neuron-specific enolase (NSE)and urinary vanilly-mandelic acid (VMA)of 24th hours decreased to a normal range. Abdominal ultrasound and whole body PET-CT showed no mass found in the original site.So far up this patient had been 4 years and 8 months of disease-free survival by follow-up. Conclusions The autologous cord blood transplantation is an safe and effective way to treat advanced stage neuroblastoma, which can further develop the conservation value of autologous cord blood.