Toor A A, Choo S Y, Little J A
Department of Medicine, University of Minnesota, Minneapolis 55455, USA.
Bone Marrow Transplant. 2000 Aug;26(3):315-20. doi: 10.1038/sj.bmt.1702490.
Therapy for acute myelogenous leukemia can be complicated by alloimmunization to histocompatibility antigens (HLA), with resultant refractoriness to platelet transfusions. Autologous peripheral blood or bone marrow stem cell transplantation (referred here collectively as 'autoBMT') is emerging as a standard consolidative strategy in acute myelogenous leukemia (AML). We had noted life-threatening bleeding associated with platelet transfusion refractoriness following autoBMT; we therefore retrospectively analyzed 39 AML patients for this complication following BMT. All patients received high-dose chemoradiotherapy, followed by infusion of allogeneic sibling donor (n = 12, alloBMT) or autologous (n = 27, autoBMT) stem cells. HLA alloimmunization was assessed if patients were suspected of immune refractoriness to random donor platelet transfusions. Within 100 days of stem cell infusion, one of three alloBMT and six of 12 autoBMT recipients tested were HLA alloimmunized (not statistically significant, NS). Five of six HLA alloimmunized autoBMT patients experienced delayed bleeding, which contributed to their demise while still in remission (P < 0.001). Increased platelet requirements in HLA alloimmunized autoBMT recipients were observed between days 61 and 100 post-BMT, at a median of 211 platelet transfusions vs 0 in non-alloimmunized autoBMT patients (P < 0.01) and 17 in alloBMT patients. Our data suggest that platelet transfusion refractoriness, when associated with HLA alloimmunization, is a risk factor for increased platelet transfusion requirements, delayed bleeding, and poor outcome following autoBMT for AML.
急性髓性白血病的治疗可能因对组织相容性抗原（HLA）的同种免疫而变得复杂，从而导致对血小板输注产生难治性。自体外周血或骨髓干细胞移植（在此统称为“自体骨髓移植”）正在成为急性髓性白血病（AML）的一种标准巩固策略。我们注意到自体骨髓移植后出现与血小板输注难治性相关的危及生命的出血情况；因此，我们对39例AML患者进行了回顾性分析，以研究骨髓移植后出现的这种并发症。所有患者均接受了大剂量放化疗，随后输注了同种异体同胞供者（n = 12，异体骨髓移植）或自体（n = 27，自体骨髓移植）干细胞。如果患者被怀疑对随机供者血小板输注存在免疫难治性，则评估其HLA同种免疫情况。在干细胞输注后的100天内，3例异体骨髓移植受者中有1例以及12例自体骨髓移植受者中有6例检测出HLA同种免疫（无统计学意义，NS）。6例HLA同种免疫的自体骨髓移植患者中有5例出现延迟性出血，这导致他们在仍处于缓解期时死亡（P < 0.001）。在骨髓移植后第61天至100天期间，观察到HLA同种免疫的自体骨髓移植受者的血小板需求量增加，中位血小板输注量为211次，而未发生同种免疫的自体骨髓移植患者为0次（P < 0.01），异体骨髓移植患者为17次。我们的数据表明，血小板输注难治性与HLA同种免疫相关时，是AML患者自体骨髓移植后血小板输注需求量增加、延迟性出血和不良预后的一个危险因素。
