Stamatović D, Balint B, Todorić-Zivanović B, Marjanović S, Lakić-Trajković Z, Malesević M
Vojnosanit Pregl. 2000 Sep-Oct;57(5):95-8.
Allogeneic bone marrow transplantation (BMT) is the treatment of choice in young patients (pts) with severe aplastic anemia (SAA) who have an HLA identical sibling donor. Late graft rejection to following allogeneic BMT for SAA is a significant clinical problem and is associated with a high risk of mortality. The optimal treatment strategy for patients with late graft rejection after first BMT is still an open question. We report 12-year-old patient with acquired SAA who underwent BMT from his HLA identical sister. BMT was first-line treatment within 3 months of diagnosis. Preparative therapy was Cyclophosphamide (Cy) 200 mg/kg body mass (BM) during 4 days. Graft versus host disease (GVHD) was prevented with Methotrexate (MTX), Methylprednisolone (MPDN) and Cyclosporin A (CsA). After 17 months, during which patient was with normal blood counts and full donor chimaerism, graft rejection occurred. The patient was re-engrafted from the same donor after conditioning with Cy 200 mg/kg BM plus horse antithymocyte globulin (ATG)--2 vials (á 25 mg)/10 kg BM over 4 days. Before the collection, donor's bone marrow was activated with low dose rhGM-CSF (3 micrograms/kg one day). Following a secondary BMT engraftment has sustained. The patient is alive with full donor chimaerism 26 months from secondary transplantation, without acute or chronic GVHD.
异基因骨髓移植（BMT）是患有严重再生障碍性贫血（SAA）且有HLA配型相合的同胞供者的年轻患者的首选治疗方法。SAA患者异基因BMT后的晚期移植物排斥是一个重大的临床问题，且与高死亡风险相关。首次BMT后发生晚期移植物排斥的患者的最佳治疗策略仍是一个悬而未决的问题。我们报告了一名12岁获得性SAA患者，他接受了来自其HLA配型相合姐姐的BMT。BMT是在诊断后3个月内的一线治疗。预处理方案为环磷酰胺（Cy）200mg/kg体重，持续4天。使用甲氨蝶呤（MTX）、甲泼尼龙（MPDN）和环孢素A（CsA）预防移植物抗宿主病（GVHD）。17个月来，患者血常规正常且完全为供者嵌合体，但之后发生了移植物排斥。患者在接受200mg/kg体重的Cy加马抗胸腺细胞球蛋白（ATG）——2瓶（每瓶25mg）/10kg体重，持续4天的预处理后，再次从同一供者处植入。在采集前，供者骨髓用低剂量重组人粒细胞巨噬细胞集落刺激因子（rhGM-CSF）（3微克/千克，1天）激活。二次BMT后植入持续。二次移植后26个月，患者存活，完全为供者嵌合体，无急性或慢性GVHD。
