Narimatsu Hiroto, Kami Masahiro, Miyakoshi Shigesaburo, Murashige Naoko, Yuji Koichiro, Hamaki Tamae, Masuoka Kazuhiro, Kusumi Eiji, Kishi Yukiko, Matsumura Tomoko, Wake Atsushi, Morinaga Shinichi, Kanda Yoshinobu, Taniguchi Shuichi
Department of Haematology, Toranomon Hospital, Tokyo, Japan.
Br J Haematol. 2006 Jan;132(1):36-41. doi: 10.1111/j.1365-2141.2005.05832.x.
We reviewed the medical records of 123 adult reduced-intensity cord blood transplantation (RI-CBT) recipients to investigate the clinical features of graft failure after RI-CBT. Nine (7.3%) had graft failure, and were classified as graft rejection rather than primary graft failure; they showed peripheral cytopenia with complete loss of donor-type haematopoiesis, implying destruction of donor cells by immunological mechanisms rather than poor graft function. Three of them died of bacterial or fungal infection during neutropenia. Two recovered autologous haematopoiesis. The remaining four patients underwent a second RI-CBT and developed severe regimen-related toxicities. One died of pneumonia on day 8, and the other three achieved engraftment. Two of them died of transplant-related mortality, and the other survived without disease progression for 9.0 months after the second RI-CBT. In total, seven of the nine patients with graft failure died. The median survival of those with graft failure was 3.8 months (range, 0.9-15.4). Graft failure is a serious complication of RI-CBT. As host T cells cannot completely be eliminated by reduced-intensity preparative regimens, we need to be aware of the difficulty in differentiating graft rejection from other causes of graft failure following RI-CBT. Further studies are warranted to establish optimal diagnostic and treatment strategies.
我们回顾了123例接受减低强度脐带血移植（RI-CBT）的成年受者的病历，以研究RI-CBT后移植物失败的临床特征。9例（7.3%）发生移植物失败，被归类为移植物排斥而非原发性移植物失败；他们表现为外周血细胞减少，供者型造血完全丧失，这意味着供者细胞被免疫机制破坏而非移植物功能不良。其中3例在中性粒细胞减少期间死于细菌或真菌感染。2例恢复了自体造血。其余4例患者接受了第二次RI-CBT，并出现了严重的预处理相关毒性。1例在第8天死于肺炎，另外3例实现了植入。其中2例死于移植相关死亡，另1例在第二次RI-CBT后无疾病进展存活了9.0个月。9例移植物失败患者中共有7例死亡。移植物失败患者的中位生存期为3.8个月（范围0.9-15.4个月）。移植物失败是RI-CBT的一种严重并发症。由于减低强度预处理方案不能完全清除宿主T细胞，我们需要意识到在RI-CBT后区分移植物排斥与其他移植物失败原因存在困难。有必要进行进一步研究以确立最佳的诊断和治疗策略。
