ABO血型主要不合异基因造血干细胞移植后纯红细胞再生障碍的临床分析  

Clinical analysis of pure red cell aplasia following major ABO-incompatible allogeneic hematopoletic stem cell transplantation

作　　者：李俊萍[1] 朱康儿[1] 张涛[1] 钟隽[1] 陈洁[1] 

机构地区：[1]暨南大学附属第一医院血液科,广州510630

出　　处：《中华器官移植杂志》2007年第11期685-688,共4页Chinese Journal of Organ Transplantation

基　　金：国务院侨办重点学科建设基金(2005)

摘　　要：目的探讨ABO血型主要不合者异基因造血干细胞移植(allo-HSCT)后并发纯红细胞再生障碍(PRCA)的危险因素、临床转归以及PRCA的治疗和预防。方法42例行allo-HSCT,其中供、受者ABO血型主要不合者33例,主次双向不合者9例,27例受者血型为O型。预处理后,13例行骨髓移植。25例行外周血干细胞移植,4例行脐血移植。6例移植前行供者型血浆置换。移植后采用环孢素A(CsA)及短程甲氨蝶呤(MTX)联用预防移植物抗宿主病(GVHD)。结果42例均获得供者细胞植入。11例移植后并发PRCA(26.2%),11例的血型均为O型,其供者9例为A型,2例为B型;移植前行供者型血浆置换的O型受者,移植后均未发生PRCA。并发PRCA的11例中,8例经红细胞输注后自然缓解,2例行供者型血浆置换,其凝集素滴度下降后缓解,1例予利妥昔单抗治疗后缓解。单因素分析表明,O型受者、A型供者以及A型供给O型者与PRCA的发生相关,多因素分析表明,A型供给O型者是发生PRCA的独立危险因素(RR为10.999,95%可信区间为1.975～61.258,P<0.05)。结论A型供给O型者与PRCA的发生密切相关;移植前行供者型血浆置换可预防PRCA的发生;供者型血浆置换和利妥昔单抗可有效治疗PRCA。Objective To study the incidence, risk factors, clinical outcome, management and prevention of pure red cell aplasia （PRCA） following major ABO-incompatible allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods Forty-two patients underwent major ABO-incompa-tible allo-HSCT, including major ABO-mismatch in 33 patients, major plus minor Air.mismatch in 9 patients, and 27 recipients with blood group O. Thirteen patients underwent bone marrow transplan- tation, 25 peripheral blood stem cell transplantation, and 4 cord blood transplantation. Six patients received donor-type plasma replacement before transplantation. Cyclosporine A （CsA） and methotrexate （MTX） were used for prophylaxis of graft-versus-host disease （GVHD）. Results All 42 patients had sustained engraftment. PRCA occurred in 11/42 patients （26. 2 %）. All the 11 cases of PRCA were in blood group O recipients of grafts from blood group A donor （n = 9） or blood group B donor （n = 2） ; 6 patients with blood group O who received donor-type plasma exchange before transplantation did not develop PRCA. PRCA resolved spontaneously in 8 cases with transfusion support. Two patients were treated by donor-type plasma exchange, resulting in the decrease of isoagglutinin titer, followed by complete recovery of erythropoiesis. One patient responded to rituximab and achieved complete remission of symptoms of PRCA. Univariate analysis revealed that the most significant risk factors associated with PRCA were blood group O recipient, blood group A donor, blood group O recipient of graft from blood group A donor; only blood group O/A in recipient/donor pair was identified as being significantly associated with the occurrence of PRCA by multivariate analysis （RR 10.999, 95 % CI 1.975-61.258, P〈0.05）. Conclusion Blood group A/O in donor/recipient pair is significantly associated with the occurrence of PRCA. PRCA could be prevented by donor-type plasma exchange before transplantation. Donor-type plasma exchange and Rituxima

关 键 词：红细胞再生障碍 纯 造血干细胞移植 ABO血液系统 血型不合 血浆置换 

分 类 号：R457.7[医药卫生—治疗学]