Hematopoietic Stem Cell Transplantation in a Very High Risk Group of Patients with the Support of Granulocyte Transfusion
Hematopoietic Stem Cell Transplantation in a Very High Risk Group of Patients with the Support of Granulocyte Transfusion
复制标题
在粒细胞输注支持下对极高危患者进行造血干细胞移植
DOI：
10.1007/s12288-011-0078-y
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发表时间：
2011
影响因子：
0.9
通讯作者：
Z. Yeğin
中科院分区：
文献类型：
--
作者：
İ. Yenicesu;G. Sucak;G. Dilsiz;Ş. Akı;Z. Yeğin
本文回顾性回顾了接受造血干细胞移植（HSCT）并辅以粒细胞输注（GTX）作为抗真菌药物的高风险活动性真菌感染患者。在Gazi大学干细胞移植中心GTX的支持下，需要立即进行同种异体造血干细胞移植治疗的原发性血液系统疾病患者（2例严重再生障碍性贫血，1例T细胞急性淋巴细胞白血病（ALL）第二次完全缓解，1例急性髓性白血病（AML）第一次完全缓解，1例难治性复发的T-ALL）由于侵袭性真菌感染而被其他移植项目拒绝。5例接受了6次移植的患者被纳入研究，在这6次移植中共接受了38（3-13）次粒细胞输注。中位粒细胞浓度为3.4 × 1011 /单采袋。5例侵袭性活动性真菌感染高危患者中，有3例在抗真菌药物和GTX联合应用后临床和影像学完全恢复。即使是一个非常高危的再生障碍性贫血患者，由于继发性移植物失败而接受了两次连续移植，尽管存在多个肺部真菌球，但他的原发疾病也治愈了。由于潜在的血液学疾病和相关的活动性真菌感染，5例具有非常高风险特征的患者中有3例在GTX联合抗真菌药物的支持下进行同种异体造血干细胞移植。尽管该报告因其回顾性而存在局限性，但它表明GTX可能是活动性真菌感染患者的另一种选择，否则移植计划将被拒绝。然而，需要前瞻性随机研究来得出关于GTX在绝望情况下（如活动性真菌感染）HSCT受者中的作用的可靠结论。
High risk patients with active fungal infection who had undergone hematopoietic stem cell transplantation (HSCT) with the support of granulocyte transfusions (GTX) as an adjunct to antifungal agents are reviewed retrospectively. Patients requiring immediate allogeneic HSCT for their primary hematological disorders (two severe aplastic anemia, one T cell acute lymphoblastic leukemia (ALL) in second complete remission, one acute myeloid leukemia (AML)-in first complete remission, one T-ALL in refractory relapse) but were denied by other transplant programs due to active invasive fungal infections had undergone HSCT with the support of GTX at the stem cell transplantation unit of Gazi University. Five patients who had undergone six transplants were included in the study and received a total of 38 (3–13) granulocyte transfusions during these six transplants. The median granulocyte concentration was 3.4 × 1011 per apheresis bag. Full clinical and radiological recovery was achieved in three of the five high risk patients with active invasive fungal infection with the combination of antifungal agents and GTX. Even a very high risk patient with aplastic anemia who had undergone two consecutive transplants due to secondary graft failure was also cured of his primary disease despite the presence of multiple pulmonary fungus balls. Three of the five patients with very high risk features due to the underlying hematological disease and the associated active fungal infection were rescued with allogeneic HSCT performed with the support of GTX combined with antifungal agents. Despite the limitations of this report due to its retrospective nature, it suggests that GTX might be an alternative in patients with active fungal infections who otherwise are denied by the transplant programs. However, prospective randomized studies are required to draw a solid conclusion regarding the role of GTX in HSCT recipients in desperate situations such as active fungal infections.