Transplantation of HLA haploidentical peripheral blood stem cell for the treatment of intestinal form of acute radiation sickness / 解放军医学杂志

ABSTRACT

Objective To investigate the significance of HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness. Methods Patient “A” from Shandong province suffered from a 60 Co radiation accident with a dose of 20-25Gy, and was diagnosed as intestinal form of acute radiation sickness. On the 3rd day after irradiation, total environmental protection (TEP), antibiotics treatment and emergency HLA zygosity with his elder sister were done, and HLA haploidentical peripheral blood stem cell transplantation was performed with a preconditioning regimen of “CTX+ATG+Flu”. The regimen for protecting from GVHD was “CsA/FK506+MMF+CD25+MSC”. Results WBC began to increase on the 17th day after treatment, and WBC recovered to 5.1?109/L on the 19th day, platelet to over 30?109/L, and RCT to normal. Bone marrow image showed hematopoietic recovery of the three cell lineages. Continuously detection of the implantation ratio of donor's cells by STR-PCR, sexual chromosome analysis and HLA zygosity showed stable complete donor-derived chimera. No GVHD was observed. On the 19th days after treatment, chest X-ray films and CT suggested that a mixed bacterial and fungous infection existed in the patient's lungs. The severest skin damage occurred on the 25th day which occupied 14% of whole body surface. The functions of lung, kidney and heart were damaged sequentially. The patient died of multiple organ failure (MOF) 33 days after admission. Conclusion It is the first time to report a successful HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness in China. A successful transplantation might be a key for prolonging the survival period of such a patient.