Acquired aplastic anemia:Is bystander insult to autologous hematopoiesis driven by immune surveillance against malignant cells?  

作　　者：Xi-Chen Zhao Xiao-Yun Sun Bo Ju Fan-Jun Meng Hong-Guo Zhao 

机构地区：[1]Department of Hematology,The Central Hospital of Qingdao West Coast New Area,Qingdao 266555,Shandong Province,China [2]Department of Hematology,The Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China

出　　处：《World Journal of Stem Cells》2020年第11期1429-1438,共10页世界干细胞杂志（英文版）（电子版）

摘　　要：We previously reported a serendipitous finding from a patient with refractory severe aplastic anemia who had gotten an unexpected hematological response to treatment with gut-cleansing preparations(GCPs).This patient experienced three recurrences over the ensuing one year of intermittent GCP treatments,with each recurrence occurring 7-8 wk from a GCP.After his third recurrence,he was prescribed successive treatment with rifampicin,berberine,and monthly administered GCP for 4 mo,and he developed an erythroid proliferative neoplasma and an overwhelming enteropathy,and eventually died of septic shock.Laboratory investigations had validated the resolution of myelosuppression and the appearance of malignant clonal hematopoiesis.From the treatment process and laboratory investigations,it is reasonably inferred that the engagement of gut inflammation is critically required in sustaining the overall pathophysiology of acquired aplastic anemia probably by creating a chronic inflammatory state.Incorporation of rifampicin,berberine,and monthly GCP into cyclosporine can enhance the immunosuppressive effect.In a subgroup of acquired aplastic anemia patients whose pathogenesis is associated with genotoxic exposure,the suppressed normal hematopoiesis may result from the bystander insult that is mediated by the soluble inflammatory cytokines generated in response to the immunogenic products of damaged hematopoietic cells in the context of chronic inflammatory state and may offer a protective antineoplastic mechanism against malignant proliferation.

关 键 词：Acquired aplastic anemia Bystander insult Malignant clonal hematopoiesis Immune surveillance ANTINEOPLASTIC Gut inflammation 

分 类 号：R556.5[医药卫生—血液循环系统疾病]