Dykes J H, Lindmark A, Lenhoff S, Winqvist I, Johansson B, Olofsson T, Olsson M L
Blood Centre, Lund University Hospital, Lund, Sweden.
Bone Marrow Transplant. 2004 Mar;33(5):559-63. doi: 10.1038/sj.bmt.1704383.
A 54-year-old RhD-negative male with del(20q)-positive myelodysplastic syndrome was transplanted with bone marrow from an HLA-identical RhD-positive sibling donor. Cytogenetic relapse was detected 21 months after stem cell transplantation (SCT), with reappearance of the original del(20q)-positive clone and reversion to recipient RhD-negative blood group. The patient received sequential donor lymphocyte infusions (DLIs), resulting in mild graft-versus-host disease and pure red cell aplasia. At 2 years post DLI, the patient remains in a stable condition, despite a dominance of recipient-derived erythro- and granulopoiesis originating in del(20q)-carrying progenitor cells. We conclude that reappearance of autologous erythropoiesis, upon relapse after allogeneic SCT, may be predictive of erythropenia after DLI and that re-emerging autologous del(20q)-positive erythropoiesis post DLI can provide a normal peripheral red blood cell count. Furthermore, in patients relapsing after blood-group-mismatched transplantation, a possible reversion to recipient blood group should be considered prior to blood transfusion or DLI.
一名54岁的RhD阴性男性，患有del(20q)阳性骨髓增生异常综合征，接受了来自HLA匹配的RhD阳性同胞供体的骨髓移植。干细胞移植（SCT）21个月后检测到细胞遗传学复发，原始的del(20q)阳性克隆再次出现，并且血型恢复为受者的RhD阴性。患者接受了序贯供体淋巴细胞输注（DLI），导致轻度移植物抗宿主病和纯红细胞再生障碍。在DLI后2年，尽管源自携带del(20q)的祖细胞的受者来源的红细胞生成和粒细胞生成占优势，但患者仍处于稳定状态。我们得出结论，异基因SCT后复发时自体红细胞生成的再次出现可能预示着DLI后出现红细胞减少，并且DLI后重新出现的自体del(20q)阳性红细胞生成可以提供正常的外周红细胞计数。此外，在血型不匹配移植后复发的患者中，在输血或DLI之前应考虑血型可能恢复为受者血型的情况。
