| 摘要: |
| 目的 探讨Rh血型不合异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的风险及疗效。方法 选择2014年2月7日上海长海医院收治的1例SAA患者作为研究对象。患者血型为Rh阴性A型,供者同胞哥哥血型为Rh阳性A型,HLA配型全相合,对其进行Rh血型不合异基因外周血造血干细胞移植治疗,预处理方案采用氟达拉滨+环磷酰胺+兔抗人胸腺细胞免疫球蛋白,观察总结其临床风险及疗效并对有关文献进行复习。结果 患者移植后+6天粒缺期出现发热,血培养提示肺炎克雷伯杆菌血流感染,给予积极抗感染治疗后体温恢复正常。+17天粒系及巨核系造血恢复,骨髓嵌合率达98.3%,但红系恢复较慢,血红蛋白持续偏低,间断给予输注少浆血支持,同时予促红素治疗,+31天复查骨髓提示红系增生活跃,血红蛋白逐步回升至正常。移植过程中,患者无明显溶血表现,共输注Rh阴性少浆血9单位,单采血小板3单位。随访至今(+15月),患者血象及骨髓象完全正常,为供者型完全植入,无急慢性移植物抗宿主病,未出现移植排斥。结论Rh血型不合异基因造血干细胞移植治疗重型再生障碍性贫血是有效、可行的。 |
| 关键词: Rh血型不合 重型再生障碍性贫血 异基因造血干细胞移植 |
| DOI：10.16781/j.0258-879x.2016.08.1053 |
| 投稿时间：2016-02-18修订日期：2016-03-23 |
| 基金项目: |
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| Treatment of severe aplastic anemia with Rh-incompatible allogeneic hematopoietic stem cell transplantation: a case report |
| YANG Dan1,WANG Li-bing1,WANG Jian-min1,QIAN Bao-hua2,LUO Yan-rong1,ZHANG Wei-ping1* |
(1. Department of Hematology, Institute of Hematology and Blood Diseases of PLA, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Blood Transfusion, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To discuss the curative effect and outcome of the Rh incompatiable allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia (SAA). Methods One patient with SAA ages 46 (Rh negative) was enrolled in this study in our center on February 7th 2014. The donor is the brother of this patient, with matched HLA and Rh positive blood type. The patient was transplanted with allogeniec hematopoietic stem cell, and the conditioning procedure included fludarabine (FLU), cyclophosphamide (CTX) and rabbit anti-human T-lymphocyte immunoglobulin (ATG). Therapeutic effect of transplantation was reported with its relevant literature reviewed. Results Day 6 after transplantation patient began fever and was diagnosed with klebsiella pneumoniae septicemia. The body temperature returned to normal after therapy. The time of neutrophil and platelet recovery was day 17. The chimeric of bone marrow was 98.3%. Constantly low hemoglobin was treated with infusion and erythropoietin. The red blood cell in bone marrow was proliferated activity on day 31, and the hemoglobin returned to normal gradually. No hemolysis, and the patient received the Rh negative plasma-reduced blood 9 units and platelet 3 units. Up to now we followed this patient for 15 months. The blood and bone marrow were normal, and the chimeric status was 100%, no graft-versus-host disease and other complications occurred. Conclusions Transplantation with Rh incompatiable allogeneic hematopoietic stem cell in treatment of SAA is a safe and effective treatment modality. |
| Key words: Rh incompatibility severe aplastic anemia allogeneic hematopoietic stem cell transplantation |
