Sanz J, Arriaga F, Montesinos P, Ortí G, Lorenzo I, Cantero S, Puig N, Moscardó F, de la Rubia J, Sanz G, Sanz M A
Hematology Department, Hospital Universitario La Fe, Valencia, Spain.
Bone Marrow Transplant. 2007 May;39(9):555-61. doi: 10.1038/sj.bmt.1705641. Epub 2007 Mar 12.
Autoimmune hemolytic anemia (AIHA) after allogeneic hematopoietic stem cell transplantation (HSCT) is still not well characterized. The aim of this study was to analyze the incidence and risk factors for the development of AIHA, as well as its prognosis and response to treatment in a series of patients undergoing allogeneic HSCT at a single institution. Between 1996 and 2004, 272 adult patients with a variety of malignant hematopoietic disorders underwent allogeneic HSCT. Direct antiglobulin testing was performed in routine pretransfusion compatibility testing or after clinical suspicion of AIHA. Twelve patients developed AIHA after HSCT at a median time of 147 days (range, 41-170). The 3-year cumulative incidence of AIHA was 4.44%. Eight cold antibodies and four warm antibodies were detected. Multivariate analysis shows that HSCT from unrelated donors (P=0.02) and the development of chronic extensive graft-versus-host disease (GVHD) (P=0.0004) were the only independent factors associated with AIHA. Two patients are still alive. AIHA was never the primary cause of death but added morbidity in patients with other concomitant complications. Patients undergoing HSCT from unrelated donors and those who develop chronic extensive GVHD are especially predisposed for this complication.
异基因造血干细胞移植（HSCT）后发生的自身免疫性溶血性贫血（AIHA）目前仍未得到充分的描述。本研究旨在分析一系列在单一机构接受异基因HSCT患者中AIHA的发生率、发生风险因素，以及其预后和对治疗的反应。1996年至2004年间，272例患有各种恶性造血系统疾病的成年患者接受了异基因HSCT。在常规输血前相容性检测或临床怀疑AIHA后进行直接抗球蛋白试验。12例患者在HSCT后发生AIHA，中位时间为147天（范围41 - 170天）。AIHA的3年累积发病率为4.44%。检测到8例冷抗体和4例温抗体。多因素分析显示，来自无关供者的HSCT（P = 0.02）和慢性广泛性移植物抗宿主病（GVHD）的发生（P = 0.0004）是与AIHA相关的仅有的独立因素。2例患者仍然存活。AIHA从未是主要死因，但会增加伴有其他并发症患者的发病率。接受来自无关供者HSCT的患者以及发生慢性广泛性GVHD的患者尤其易发生这种并发症。
