切换至 "中华医学电子期刊资源库"

中华细胞与干细胞杂志(电子版) ›› 2019, Vol. 09 ›› Issue (06) : 358 -362. doi: 10.3877/cma.j.issn.2095-1221.2019.06.007

所属专题: 文献

综述

异基因造血干细胞移植后并发自身免疫性溶血性贫血的治疗进展
龚悦1, 陈静1,()   
  1. 1. 200127 上海交通大学附属上海儿童医学中心
  • 收稿日期:2019-07-01 出版日期:2019-12-01
  • 通信作者: 陈静

Progress in the treatment of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation

Yue Gong1, Jing Chen1,()   

  1. 1. Department of Hematology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai 200127, China
  • Received:2019-07-01 Published:2019-12-01
  • Corresponding author: Jing Chen
  • About author:
    Corresponding author: Chen Jing, Email:
引用本文:

龚悦, 陈静. 异基因造血干细胞移植后并发自身免疫性溶血性贫血的治疗进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2019, 09(06): 358-362.

Yue Gong, Jing Chen. Progress in the treatment of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation[J/OL]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2019, 09(06): 358-362.

异基因造血干细胞移植(HSCT)后自身免疫性溶血性贫血(AIHA)是HSCT后并不少见的并发症,其发病率约1﹪~ 6﹪,不同于一般的AIHA,HSCT后AIHA发病机制尚未完全明确,可能与HSCT后受者体内免疫失调相关。危险因素与移植患者年龄小、非恶性疾病、使用无关供者、半相合供者移植、脐血移植、去T细胞移植及移植后并发慢性移植物抗宿主病(GVHD)等有关。皮质激素作为一线治疗,疗效有限,难以持续缓解,需联合使用利妥昔单抗(RTX)、大剂量丙种球蛋白等,甚至需要联合霉酚酸酯、环磷酰胺、西罗莫司、阿伦单抗、依库丽单抗或蛋白酶体抑制剂硼替佐米等免疫抑制剂治疗,部分患者需行血浆置换,偶有行脾切除术者。移植后AIHA总死亡率常高达50﹪,总体预后差于单纯AIHA。该综述旨在总结HSCT后并发AIHA的最新治疗进展,供临床医师参考。

Autoimmune hemolytic anemia (AIHA) is not a rare complication of allogeneic hematopoietic stem cell transplantation (HSCT) , the incidence of AIHA after HSCT ranges between about 1﹪ to 6﹪. Different from common AIHA, the pathogenesis of AIHA after HSCT is not completely clear, which may be related to immune dysregulation after HSCT. Risk factors include young age, non-malignant disease, use of unrelated donors, haploidentical transplant, cord blood transplantation, T-cell depletion and presence of chronic graft-versus-host disease (GvHD) . As a first-line therapy, steroids often have limited therapeutic effects and are difficult to sustain remission. Therefore, they often need a combination of rituximab, large dose of immunoglobulins, even need to further joint immunosuppressive agents such as mycophenolate mofetil, cyclophosphamide, sirolimus, alemtuzumab, eculizumab, proteasome inhibitors bortezomib and so on. Some patients receive plasma exchange, occasionally splenectomy. The overall prognosis is significantly worse than primary AIHA, and the total mortality of AIHA after HSCT is often up to 50﹪. This review aims to summarize the latest treatment progress of AIHA after HSCT for clinicians' reference.

图1 异基因造血干细胞移植后自身免疫性溶血性贫血的治疗
1
Gonzalez-Vicent M, Sanz J, Luis Fuster J, et al. Autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (HSCT): A retrospective analysis and a proposal of treatment on behalf of the Grupo Espanol De Trasplante de Medula Osea en Nimos (GETMON) and the Grupo Espanol de Trasplante Hematopoyetico (GETH)[J]. Transfus Med Rev, 2018, 32(3):179-185.
2
Page KM, Mendizabal AM, Prasad VK, et al. Posttransplant autoimmune hemolytic anemia and other autoimmune cytopenias are increased in very young infants undergoing unrelated donor umbilical cord blood transplantation[J]. Biol Blood Marrow Transplant, 2008, 14(10):1108-1117.
3
Wang M, Wang W, Abeywardane A, et al. Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: analysis of 533 adult patients who underwent transplantation at king's college hospital[J]. Biol Blood Marrow Transplant, 2015, 21(1):60-66.
4
Faraci M, Zecca M, Pillon M, et al. Autoimmune hematological diseases after allogeneic hematopoietic stem cell transplantation in children:an Italian multicenter experience[J]. Biol Blood Marrow Transplant, 2014, 20(2):272-278.
5
O'brien TA, Eastlund T, Peters C, et al. Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in paediatric patients: high incidence and significant mortality in unrelated donor transplants for non-malignant diseases[J]. Br J Haematol, 2004, 127(1):67-75.
6
Sanz J, Arango M, Carpio N, et al. Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience[J]. Bone Marrow Transplant, 2014, 49(8):1084-1088.
7
Lv WR, Liu QF, Fan ZP, et al. Autoimmune hematological diseases following haploidentical donor hematopoietic stem cell transplant compared with matched sibling and unrelated donor[J]. Blood, 2016, 128(22):26505-26514.
8
Barcellini W. Current treatment strategies in autoimmune hemolytic disorders[J]. Expert Rev Hematol, 2015, 8(5):681-691.
9
中华医学会血液学分会红细胞疾病(贫血)学组. 自身免疫性溶血性贫血诊断与治疗中国专家共识(2017年版)[J]. 中华血液学杂志, 2017, 38(4): 265-267.
10
Zanella A, Barcellini W. Treatment of autoimmune hemolytic anemias[J]. Haematologica, 2014, 99(10):1547-1554.
11
王超,薛胜利,李正, 等. 异基因造血干细胞移植后自身免疫性溶血性贫血一例并文献复习[J]. 白血病·淋巴瘤, 2018, 27(4):228-233,237.
12
Halligan K, Vasiljevic L, Roehrs P, et al. Use of eculizumab in a patient with refractory autoimmune hemolytic anemia with heterozygous NFκB1 mutation[J]. Blood, 2017, 130(1):4743.
13
Crowther M, Chan Y, Garbett IK, et al. Evidence-based focused review of the treatment of idiopathic warm immune hemolytic anemia in adults[J]. Blood, 2011, 118(15):4036-4040.
14
Bisharat N, Omari H, Lavi I, et al. Risk of infection and death among post-splenectomy patients[J]. J Infect, 2001,43(3):182-186.
15
Hosoba S, Jaye DL, Cohen C, et al. Successful treatment of severe immune hemolytic anemia after allogeneic stem cell transplantation with bortezomib: report of a case and review of literature[J]. Transfusion, 2015, 55(2):259-264.
16
Pimentel-Quiroz VR, Ugarte-Gil MF, Alarcon GS. Abatacept for the treatment of systemic lupus erythematosus[J]. Expert Opin Investig Drugs, 2016, 25(4):493-499.
17
Visentini M, Tinelli C, Colantuono S, et al. Efficacy of low-dose rituximab for the treatment of mixed cryoglobulinemia vasculitis: Phase II clinical trial and systematic review[J]. Autoimmun Rev, 2015, 14: 889-896.
18
Barcellini W, Fattizzo B, Zaninoni A, et al. Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: a GIMEMA study of 308 patients[J]. Blood, 2014, 124(19):2930-2936.
19
高清妍,刘晨曦,李园, 等. 小剂量利妥昔单抗治疗12例难治/复发原发性自身免疫性溶血性贫血患者疗效分析[J]. 中华血液学杂志, 2017, 38(12):1075-1077.
20
Barcellini W, Fattizzo B, Zaninoni A. Current and emerging treatment options for autoimmune hemolytic anemia[J]. Expert Rev Clin Immunol, 2018, 14(10):857-872.
21
Li X, Huang J, Zhu Z, et al. Refractory autoimmune haemolytic anaemia following allogenic haematopoietic stem cell transplantation: successful treatment of rituximab[J]. J Int Med Res, 2019, 47(7):3320-3331.
22
Lechner K, Jaeger U. How I treat autoimmune hemolytic anemias in adults[J]. Blood, 2010, 116(11):1831-1838.
23
Schuetz C, Hoenig M, Moshous D, et al. Daratumumab in life-threatening autoimmune hemolytic anemia following hematopoietic stem cell transplantation[J]. Blood, 2018, 2(19):2550-2553.
24
O'connell N, Goodyer M, Gleeson M, et al. Successful treatment with rituximab and mycophenolate mofetil of refractory autoimmune hemolytic anemia post-hematopoietic stem cell transplant for dyskeratosis congenita due to TINF2 mutation[J]. Pediatr Transplant, 2014, 18(1):E22-E24.
25
Park JA, Lee HH, Kwon HS, et al. Sirolimus for refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: a case report and literature review of the treatment of Post-Transplant autoimmune hemolytic anemia[J]. Transfus Med Rev, 2016, 30(1):6-14.
26
Hess J, Su L, Nizzi F, et al. Successful treatment of severe refractory autoimmune hemolytic anemia after hematopoietic stem cell transplant with abatacept[J]. Transfusion, 2018, 58(9):2122-2127.
27
Anderson D, Ali K, Blanchette V, et al. Guidelines on the use of intravenous immune globulin for hematologic conditions[J]. Transfus Med Rev, 2007, 21(2, 1):S9-S56.
28
Hartert A, Willenbacher W, Gunzelmann S, et al. Successful treatment of thrombocytopenia and hemolytic anemia with IvIG in a patient with lupus-like syndrome after mismatched related PBSCT[J]. Bone Marrow Transplant, 2001, 27(3):337-340.
29
Ruivard M, Tournilach O, Montel S, et al. Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: a retrospective case-control study[J]. J Clin Apher, 2006, 21: 202-206.
[1] 陈帅, 刘文宾, 吴迪炯, 俞庆宏, 陈均法, 庄海峰, 胡致平, 武利强, 郑智茵, 沈建平, 叶宝东. 改良FAC预处理方案在不同供者类型行异基因造血干细胞移植治疗再生障碍性贫血中的疗效分析[J/OL]. 中华危重症医学杂志(电子版), 2022, 15(04): 296-299.
[2] 李雪, 韩萌萌, 冯雪园, 马宁. 人表皮生长因子受体2低表达乳腺癌的研究进展及挑战[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 308-312.
[3] 吴文娟, 王小莉, 刘娟. 乳腺结节微创手术治疗进展研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 229-232.
[4] 刘麾, 赵鹏, 冯静, 胡晓彦, 杜涛, 王凌云. 三维调强放射治疗对急性髓系白血病异基因造血干细胞移植后髓外复发的疗效观察[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 110-115.
[5] 李赞, 许芝彬, 冯志金, 张雄. 重型β-地中海贫血患儿异基因造血干细胞移植后淋巴细胞亚群动态分析[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 22-29.
[6] 孔欣, 宋宝全, 刘吟, 张剑, 仇惠英, 吴德沛. 异基因造血干细胞移植并发难治性呃逆一例[J/OL]. 中华移植杂志(电子版), 2023, 17(04): 253-255.
[7] 王向丽, 吴涛, 毛东锋, 刘恒, 刘文慧, 周芮, 田红娟. 异基因造血干细胞移植治疗ANKRD26相关性血小板减少症1例并文献复习[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(04): 236-238.
[8] 刘洋, 吴涛, 刘恒, 刘文慧, 田红娟, 周芮, 高铭敏, 王向丽, 张睿. 异基因造血干细胞移植治疗CSF3R基因突变急性髓系白血病M2型1例并文献复习[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(02): 90-92.
[9] 刘文慧, 吴涛, 张曦. 间充质干细胞联合血小板生成素受体激动剂在异基因造血干细胞移植后血小板恢复中的研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2023, 13(04): 242-246.
[10] 李芸芸, 吴涛, 毛东锋, 鱼玲玲, 刘文慧. 轻型β-地中海贫血供者异基因造血干细胞移植治疗重型再生障碍性贫血1例[J/OL]. 中华细胞与干细胞杂志(电子版), 2023, 13(02): 84-86.
[11] 苏春艳, 吴涛, 毛东锋, 刘文慧, 鱼玲玲, 白海. 异基因造血干细胞移植治疗急性混合细胞白血病后继发外周T细胞淋巴瘤1例[J/OL]. 中华细胞与干细胞杂志(电子版), 2022, 12(05): 289-292.
[12] 张龙, 孙善柯, 徐伟, 李文柱, 李俊达, 池涌泉, 何广胜, 成峰, 王学浩, 饶建华. 腹腔镜脾切除治疗血液系统疾病的临床疗效分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 870-875.
[13] 邓朝林, 吴斌. 结直肠癌黏液腺癌临床病理及治疗进展[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(04): 325-328.
[14] 金炜. 骨髓增生异常/骨髓增殖性肿瘤伴环形铁粒幼细胞和血小板增多的临床特点及治疗进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(01): 101-104.
[15] 赵洁, 王岚, 杨红枚, 何屹, 袁红. 异基因造血干细胞移植后并发自身免疫性溶血性贫血患者产生类抗体血清学检测方法及输血策略[J/OL]. 中华临床医师杂志(电子版), 2022, 16(05): 452-456.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?