Yang Zhen, Wu Bangzhao, Zhou Youning, Wang Wenjuan, Chen Suning, Sun Aining, Wu Depei, Xu Yang
Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis, Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis, Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China. Email:
Chin Med J (Engl). 2014;127(7):1235-8.
Autoimmune hemolytic anemia (AIHA) is an uncommon complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) which has only been reported in a few cases. We here aimed to explore its mechanism.
We retrospectively analyzed 296 patients who underwent allo-HSCT in our center from July 2010 to July 2012. Clinical manifestations were carefully reviewed and the response to currently available treatment approaches were evaluated. The survival and risk factors of AIHA patients after allo-HSCT were further analyzed.
Twelve patients were diagnosed with AIHA at a median time of 100 days (15-720 days) after allo-HSCT. The incidence of AIHA after allo-HSCT was 4.1%. IgG antibody were detected in ten patients and IgM antibody in two patients. The two cold antibody AIHA patients had a better response to steroid corticoid only treatment and the ten warm antibody AIHA patients responded to corticosteroid treatment and adjustment of immunosuppressant therapy. Rituximab was shown to be effective for AIHA patients who failed conventional therapy. Survival analysis showed that the combination of AIHA in allo-HSCT patients hinted at poor survival. Cytomegalovirus (CMV) infection, graft-versus-host disease (GVHD) and histocompatibility leukocyte antigen (HLA) mismatch seemed to increase the risk of developing AIHA.
Patients who develop AIHA after allo-HSCT have poor survival compared to non-AIHA patients. Possible risk factors of AIHA are CMV infection, GVHD, and HLA mismatch. Rituximab is likely to be the effective treatment choice for the refractory patients.
自身免疫性溶血性贫血（AIHA）是异基因造血干细胞移植（allo-HSCT）的一种罕见并发症，仅在少数病例中有报道。我们旨在探讨其发病机制。
回顾性分析2010年7月至2012年7月在本中心接受allo-HSCT的296例患者。仔细回顾临床表现并评估对现有治疗方法的反应。进一步分析allo-HSCT后AIHA患者的生存情况及危险因素。
12例患者在allo-HSCT后中位时间100天（15 - 720天）被诊断为AIHA。allo-HSCT后AIHA的发生率为4.1%。10例患者检测到IgG抗体，2例患者检测到IgM抗体。2例冷抗体AIHA患者仅对糖皮质激素治疗反应良好，10例温抗体AIHA患者对糖皮质激素治疗及免疫抑制剂治疗调整有反应。利妥昔单抗对常规治疗无效的AIHA患者有效。生存分析表明，allo-HSCT患者合并AIHA提示生存不良。巨细胞病毒（CMV）感染、移植物抗宿主病（GVHD）和人类白细胞抗原（HLA）不匹配似乎增加了发生AIHA的风险。
与非AIHA患者相比，allo-HSCT后发生AIHA的患者生存较差。AIHA可能的危险因素是CMV感染、GVHD和HLA不匹配。利妥昔单抗可能是难治性患者的有效治疗选择。
