Rh血型不合异基因造血干细胞移植治疗重型再生障碍性贫血1例报告

1 病例资料 患者,女,46岁,2013年4月始出现月经量增多,开始未予重视.2013年7月因“头晕、乏力反复”至当地医院就诊,血常规示:WBC (1.40～3.08)×109/L、Hb 74～86 g/L、PLT (25～60)×109/L.进一步行骨髓检查,骨髓细胞形态学提示“骨髓增生减低,粒红比例减低,巨核细胞全片0～1个”,骨髓活检病理示“骨髓造血组织增生减低,脂肪细胞明显增多”,染色体示“46,XX”,诊断为“再生障碍性贫血”.2013年9月初开始予环孢素A(cyclosporin A,CsA) 200 mg/d口服治疗,期间曾反复多次给予血制品输注及细胞因子支持,但疗效不佳.

Treatment of severe aplastic anemia with Rh-incompatible allogeneic hematopoietic stem cell transplantation: a case report

Objective To discuss the curative effect and outcome of the Rh incompatiable allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia (SAA). Methods One patient with SAA ages 46 (Rh negative) was enrolled in this study in our center on February 7th 2014. The donor is the brother of this patient, with matched HLA and Rh positive blood type. The patient was transplanted with allogeniec hematopoietic stem cell, and the conditioning procedure included fludarabine (FLU), cyclophosphamide (CTX) and rabbit anti-human T-lymphocyte immunoglobulin (ATG). Therapeutic effect of transplantation was reported with its relevant literature reviewed. Results Day 6 after transplantation patient began fever and was diagnosed with klebsiella pneumoniae septicemia. The body temperature returned to normal after therapy. The time of neutrophil and platelet recovery was day 17. The chimeric of bone marrow was 98.3%. Constantly low hemoglobin was treated with infusion and erythropoietin. The red blood cell in bone marrow was proliferated activity on day 31, and the hemoglobin returned to normal gradually. No hemolysis, and the patient received the Rh negative plasma-reduced blood 9 units and platelet 3 units. Up to now we followed this patient for 15 months. The blood and bone marrow were normal, and the chimeric status was 100%, no graft-versus-host disease and other complications occurred. Conclusions Transplantation with Rh incompatiable allogeneic hematopoietic stem cell in treatment of SAA is a safe and effective treatment modality.