严重再生障碍性贫血中的粒细胞输注：十一年经验。
Granulocyte transfusions in severe aplastic anemia: an eleven-year experience.
机构信息
Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA.
出版信息
Haematologica. 2009 Dec;94(12):1661-8. doi: 10.3324/haematol.2009.010231.
BACKGROUND
Infections, particularly those caused by invasive fungi, are a major cause of death in patients with severe aplastic anemia. The purpose of this study was to analyze our experience with granulocyte transfusions in such patients.
DESIGN AND METHODS
A retrospective analysis was performed on all patients with severe aplastic anemia who had received granulocyte transfusions between 1997 and 2007 in our institute. Survival to hospital discharge was the primary outcome. Secondary outcomes included microbiological, radiographic and clinical responses of the infection at 7 and 30 days after initiating granulocyte therapy, and post-transfusion absolute neutrophil count, stratified by HLA alloimmunization status.
RESULTS
Thirty-two patients with severe aplastic anemia underwent granulocyte transfusions; the majority had received horse antithymocyte globulin and cyclosporine A. One quarter of patients had demonstrable HLA alloimmunization prior to the initiation of granulocyte therapy. Infections were evenly divided between invasive bacterial and fungal infections unresponsive to maximal antibiotic and/or antifungal therapy. The median number of granulocyte components transfused was nine (range, 2-43). The overall survival to hospital discharge was 58%. Survival was strongly correlated with hematopoietic recovery. Among the 18 patients who had invasive fungal infections, 44% survived to hospital discharge. Response at 7 and 30 days correlated with survival. The mean post-transfusion absolute neutrophil count did not differ significantly between response groups (i.e. patients grouped according to whether they had complete or partial resolution of infection, stable disease or progressive infection). There was also no difference in mean post-transfusion absolute neutrophil count between the patients divided according to HLA alloimmunization status.
CONCLUSIONS
Granulocyte transfusions may have an adjunctive role in severe infections in patients with severe aplastic anemia. HLA alloimmunization is not an absolute contraindication to granulocyte therapy.
背景
感染，尤其是侵袭性真菌感染，是重型再生障碍性贫血患者死亡的主要原因。本研究旨在分析我们在该类患者中应用粒细胞输注的经验。
方法
对 1997 年至 2007 年期间我院接受粒细胞输注的重型再生障碍性贫血患者进行回顾性分析。主要转归为住院期间存活至出院。次要转归包括感染发生后 7 天和 30 天的微生物学、影像学和临床反应，以及根据 HLA 同种免疫状态分层的输注后绝对中性粒细胞计数。
结果
32 例重型再生障碍性贫血患者接受了粒细胞输注；大多数患者接受了马抗胸腺细胞球蛋白和环孢素 A。在开始粒细胞治疗前，1/4 的患者存在可检测的 HLA 同种免疫。感染在侵袭性细菌感染和对抗生素和/或抗真菌治疗无反应的真菌感染之间平分秋色。输注的粒细胞成分中位数为 9 个（范围，2-43 个）。总体住院期间存活率为 58%。存活率与造血恢复密切相关。在 18 例侵袭性真菌感染患者中，44%存活至出院。7 天和 30 天的反应与存活率相关。反应组之间（即根据感染是否完全或部分缓解、疾病稳定或进行性感染分组的患者）输注后平均绝对中性粒细胞计数无显著差异。根据 HLA 同种免疫状态分层的患者之间的平均输注后绝对中性粒细胞计数也无差异。
结论
粒细胞输注可能对重型再生障碍性贫血患者的严重感染具有辅助作用。HLA 同种免疫不是粒细胞治疗的绝对禁忌证。
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