Takahata M, Fukuhara T, Shigematsu A, Onozawa M, Yamamoto Y, Miyake T, Maekawa I
Department of Internal Medicine, Asahikawa City Hospital, Kinseicho, Asahikawa, Japan.
Transpl Infect Dis. 2006 Mar;8(1):44-8. doi: 10.1111/j.1399-3062.2006.00120.x.
A 43-year-old woman with severe aplastic anemia (SAA) received anti-thymocyte globulin and cyclosporin A (CyA) and achieved hematological remission. Although she had maintained hematological remission, the disease relapsed 10 months after arbitrary discontinuance of maintenance therapy with CyA. Resumption of CyA therapy was not effective, and her condition became complicated with progressive sinusitis with bone destruction, which was refractory to antibiotics, antifungal agents, granulocyte colony-stimulating factor, and surgical drainage. Because of the necessity for early neutrophil recovery (to resolve the infection), we proceeded with a combination therapy using allogeneic peripheral blood stem cell transplantation (PBSCT) promptly followed by granulocyte transfusion (GTX) from the same human leukocyte antigen-identical donor rather than carrying out a second immunosuppressive therapy. The patient showed temporal resolution of infection on the second day after a single GTX. Although the patient had pneumonia on day 11, it was resolved promptly after engraftment on day 16. This report suggests the clinical utility of a salvage therapy with allogeneic PBSCT followed by GTX in a particular case of recurrent SAA with refractory infections.
一名43岁的重型再生障碍性贫血（SAA）女性患者接受了抗胸腺细胞球蛋白和环孢素A（CyA）治疗并实现血液学缓解。尽管她维持了血液学缓解，但在随意停用CyA维持治疗10个月后疾病复发。恢复CyA治疗无效，且她的病情并发了伴有骨质破坏的进行性鼻窦炎，对抗生素、抗真菌药、粒细胞集落刺激因子及手术引流均难治。由于需要早期恢复中性粒细胞（以解决感染问题），我们迅速进行了异基因外周血干细胞移植（PBSCT）联合治疗，随后立即从同一个人类白细胞抗原相同供体进行粒细胞输注（GTX），而不是进行第二次免疫抑制治疗。患者在单次GTX治疗后的第二天感染得到暂时缓解。尽管患者在第11天出现肺炎，但在第16天植入后迅速得到缓解。本报告提示了在复发性SAA伴难治性感染的特定病例中，采用异基因PBSCT联合GTX的挽救治疗的临床实用性。
