ABO血型次要不合的异基因造血干细胞移植合并过客淋巴细胞综合征患者的诊治  

Diagnosis and treatment of passenger lymphocyte syndrome following secondary ABO-incompatible allogeneic hematopoietic stem cell transplantation

作　　者：邵迎春 周士源[2] 朱倩 窦广刚 马骁[2] 吴小津[2] 马超 SHAO Yingchun;ZHOU Shiyuan;ZHU Qian;DOU Guanggang;MA Xiao;WU Xiaojin;MA Chao(Suzhou Hongci Hematology Hospital,Suzhou 215000,China;The First Affiliated Hospital of Soochow University)

机构地区：[1]苏州弘慈血液病医院有限公司检验科,江苏苏州215000 [2]苏州大学附属第一医院

出　　处：《中国输血杂志》2023年第11期995-999,共5页Chinese Journal of Blood Transfusion

基　　金：苏州市卫生健康委科研项目(LCZX202101)。

摘　　要：目的探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)患者发生过客淋巴细胞综合征(passenger lymphocyte syndrome,PLS)的临床特点和诊治方法。方法回顾2018年12月至2022年12月在苏州弘慈血液病医院行allo-HSCT的489名患者。分析移植后并发PLS的4名患者的临床过程、诊治措施及预后。结果489名allo-HSCT患者中,4例确诊为PLS,供受体ABO血型均为次要不合(O供A或B)。PLS在allo-HSCT中的总体发生率为0.82%(4/489),在供受体ABO血型次要不合的移植中发生率为2.2%(4/179)。PLS发生在供体干细胞回输6~13 d,临床表现为头晕乏力明显,腰痛、黄疸、尿色加深,实验室检查血红蛋白迅速下降,间接胆红素、乳酸脱氢酶升高,尿胆原阳性、直接抗人球蛋白试验(DAT)阳性,并且血浆中均检测出针对受者红细胞的抗-A或抗-B。治疗上予以输注O型洗涤红细胞,甲强龙,丙种球蛋白、利妥昔单抗等治疗后患者溶血表现改善。所有患者都获得了粒系、血小板植入,并且红细胞脱离输注时间均在3周内。结论PLS是异基因造血干细胞移植少见的并发症,主要发生在ABO血型次要不合的allo-HSCT患者中,及时处置临床预后良好。Objective To investigate the clinical characteristics and diagnosis and treatment of passenger lymphocyte syndrome(PLS)in patients following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A total of 489 patients who underwent allo-HSCT in Suzhou Hongci Hematology Hospital were retrospectively enrolled.The clinical process,diagnosis and treatment measures and prognosis of four patients complicated with PLS after transplantation were analyzed.Results Among the 489 patients,4 were diagnosed with PLS.The blood types of donor/recipient ABO were all secondary incompatible(The blood type of donors were O and the recipients were A or B).The overall incidence of PLS in allo-HSCT was 0.82%(4/489)and 2.2%(4/179)in transplants with donor/recipient secondary incompatible ABO-blood types.PLS occured in 6-13 days after donor stem cell infusion.Clinical manifestations were dizziness and fatigue,low back pain,jaundice,deepening urine,rapid decrease in hemoglobin on laboratory tests,elevated indirect bilirubin and lactate dehydrogenase,positive urobilinogen,positive direct anti-human globulin test(DAT),and anti-A or anti-B antibodies against recipient red blood cells were detected in plasma.After the treatment of O-type washed red blood cells,methylprednisolone,gamma globulin,rituximab and other treatments,the hemolysis was improved.All patients achieved engraftment of neutrophil and platelet.Red blood cell transfusion was halted in 3 weeks.Conclusion PLS is a rare complication of allo-HSCT,which mainly occurs in allo-HSCT patients with secondary incompatibility of ABO blood group of donor/recipient.The clinical prognosis is good after properly treatment.

关 键 词：过客淋巴系统综合征 造血干细胞移植 ABO血型系统 溶血 

分 类 号：R457.1[医药卫生—治疗学] R557.4[医药卫生—临床医学]