Clinical and serological characterization of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation
Clinical and serological characterization of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation
复制标题
异基因造血干细胞移植后自身免疫性溶血性贫血的临床和血清学特征
DOI：
10.3760/cma.j.issn.0366-6999.20132823
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发表时间：
2014-04-05
影响因子：
6.1
通讯作者：
Xu Yang
中科院分区：
文献类型：
--
作者：
Yang Zhen;Wu Bangzhao;Xu Yang
背景自身免疫性溶血性贫血(AIHA)是异基因造血干细胞移植(allo-HSCT)的罕见并发症，目前仅有少数病例报道。方法对2010年7月至2012年7月在我中心接受allo-HSCT的296例患者进行回顾性分析。仔细回顾了临床表现，并评估了对现有治疗方法的反应。结果12例患者在allo-HSCT后的中位时间为100天(15-720天)确诊为AIHA。Allo-HSCT后AIHA发生率为4.1%。10例患者检测到免疫球蛋白抗体，2例检测到免疫球蛋白M抗体。2例冷抗体AIHA患者单用糖皮质激素治疗效果较好，10例温抗体AIHA患者对糖皮质激素治疗和免疫抑制调整治疗有效。利妥昔单抗被证明对常规治疗失败的AIHA患者有效。生存分析显示，在allo-HSCT患者中，联合应用AIHA暗示存活率较低。巨细胞病毒(CMV)感染、移植物抗宿主病(GVHD)和组织相容白细胞抗原(HLA)不匹配可能增加发生AIHA的风险。结论allo-HSCT后发生AIHA的患者较非AIHA患者存活率低。巨细胞病毒感染、移植物抗宿主病和人类白细胞抗原不匹配是AIHA的可能危险因素。利妥昔单抗有可能成为难治性患者的有效治疗选择。
Background Autoimmune hemolytic anemia (AIHA) is an uncommon complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) which has only been reported in a few cases. We here aimed to explore its mechanism.Methods We retrospectively analyzed 296 patients who underwent allo-HSCT in our center from July 2010 to July 2012. Clinical manifestations were carefully reviewed and the response to currently available treatment approaches were evaluated. The survival and risk factors of AIHA patients after allo-HSCT were further analyzed.Results Twelve patients were diagnosed with AIHA at a median time of 100 days (15-720 days) after allo-HSCT. The incidence of AIHA after allo-HSCT was 4.1%. IgG antibody were detected in ten patients and IgM antibody in two patients. The two cold antibody AIHA patients had a better response to steroid corticoid only treatment and the ten warm antibody AIHA patients responded to corticosteroid treatment and adjustment of immunosuppressant therapy. Rituximab was shown to be effective for AIHA patients who failed conventional therapy. Survival analysis showed that the combination of AIHA in allo-HSCT patients hinted at poor survival. Cytomegalovirus (CMV) infection, graft-versus-host disease (GVHD) and histocompatibility leukocyte antigen (HLA) mismatch seemed to increase the risk of developing AIHA.Conclusions Patients who develop AIHA after allo-HSCT have poor survival compared to non-AIHA patients. Possible risk factors of AIHA are CMV infection, GVHD, and HLA mismatch. Rituximab is likely to be the effective treatment choice for the refractory patients.