异基因造血干细胞移植治疗合并肝腺瘤血液病患者8例临床分析  

Prognostic analysis of 8 patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation

作　　者：何云[1] 徐郑丽[1] 马瑞 刘静 张园园 吕萌[1] 莫晓冬[1] 闫晨华[1] 孙于谦[1] 张新羽[2] 王昱[1] 张晓辉[1] 黄晓军[1] 许兰平[1] He Yun;Xu Zhengli;Ma Rui;Liu Jing;Zhang Yuanyuan;Lyu Meng;Mo Xiaodong;Yan Chenhua;Sun Yuqian;Zhang Xinyu;Wang Yu;Zhang Xiaohui;Huang Xiaojun;Xu Lanping(Peking University People’s Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing 100044,China;Peking University People’s Hospital Department of Medical imaging,Beijing 100044,China)

机构地区：[1]北京大学人民医院血液科,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,造血干细胞移植治疗血液病北京市重点实验室,北京100044 [2]北京大学人民医院影像科,北京100044

出　　处：《中华血液学杂志》2024年第9期816-820,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金青年科学基金项目(81800116)。

摘　　要：目的评估异基因造血干细胞移植(allo-HSCT)治疗合并肝腺瘤的血液病患者的安全性。方法纳入2010年1月至2024年3月在北京大学人民医院血液科接受allo-HSCT的8例合并肝腺瘤血液病患者,对其临床特征及预后进行回顾性分析。结果8例患者中,再生障碍性贫血7例,骨髓增生异常综合征低增生型1例,中位年龄23(13~48)岁,原发病诊断到移植的中位时间为14(6~24)年。服用雄激素到诊断肝腺瘤的中位时间为9(5~13)年。单倍体移植6例,全相合无关供者、全相合同胞供者移植各1例。8例患者中位中性粒细胞植入时间为11.5(11~20)d,中位血小板植入时间为19(10~37)d。7例患者移植后发生巨细胞病毒血症,3例患者发生出血性膀胱炎,2例患者发生急性GVHD。8例患者移植期间及移植后均未出现严重肝功能损害及肝腺瘤破裂出血。4例患者移植后影像学评估肝腺瘤不同程度缩小,另外4例无明显变化。中位随访时间540.5(30~2989)d,8例中6例存活,2例死亡,死亡与肝腺瘤无直接相关性。结论肝腺瘤对血液病患者allo-HSCT的安全性无不良影响。ObjectiveTo evaluate the safety of patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT).MethodsA retrospective analysis of the clinical characteristics and prognosis of eight patients with hepatic adenoma who underwent allo-HSCT in the Hematology Department of Peking University People’s Hospital from January 2010 to March 2024 was conducted.ResultsOf the eight patients who underwent allo-HSCT with hepatic adenoma,one patient was considered MDS-h transfusion-dependent and seven had aplastic anemia.The median age of the patients was 23 years(13-48 years).The median time from the diagnosis of AA or MDS to transplantation was 14 years(6-24 years),whereas the median time from taking androgens to diagnosing hepatic adenoma was 9 years(5-13 years).Six cases underwent haplo-HSCT,one case underwent matched unrelated donor HSCT,and one case underwent matched related donor HSCT.All patients achieved neutrophil engraftment at a median time of 11.5 days(11-20 days)and PLT engraftment within 60 days at a median of 19 days(10-37 days)after haplo-HSCT.Moreover,seven patients developed CMV anemia after transplantation,three patients had hemorrhagic cystitis,and two patients developed acute GVHD.During and after transplantation,eight patients did not show severe liver function damage or rupture of hepatic adenoma.In relation to imaging size,four patients showed varying degrees of reduction in hepatic adenoma size after transplantation,whereas four patients did not show significant changes in hepatic adenoma size after transplantation.The median follow-up time was 540.5(30-2989)days.Of the eight patients,six survived and two died.Furthermore,no direct correlation was observed between death and hepatic adenoma.ConclusionPatients with hepatic adenomas undergoing allo-HSCT are not contraindications for transplantation,which will not increase transplant-related mortality.

关 键 词：腺瘤 肝细胞 异基因造血干细胞移植 再生障碍性贫血 骨髓增生异常综合征 

分 类 号：R457.7[医药卫生—治疗学] R735.7[医药卫生—临床医学]