Kawaguch Koji, Matsubara Kousaku, Uchida Yoshiko, Saito Atsuro, Miyata Kenji, Hasegawa Daiichiro, Kosaka Yoshiyuki, Iwata Aya, Nigami Hiroyuki, Kobayashi Masao
Department of Pediatrics, Nishi-Kobe Medical Center.
Rinsho Ketsueki. 2014 Nov;55(11):2294-9.
We report a 4-year-old boy with severe congenital neutropenia (SCN), who was successfully treated with hematopoietic stem cell transplantation (HSCT). The patient had frequently developed bacterial infections since 6 months of age, and showed severe neutropenia below 100/μl at 1 year and 4 months of age. The patient harbored a heterozygous missense mutation in ELANE exon 3 (p.Q73P, g.2253 A>C). This was a novel de novo mutation, and he was thus diagnosed as having SCN. Because of failure to respond to granulocyte colony-stimulating factor treatment and repeated admissions due to bacterial infections, allogeneic HSCT was performed from a serologically matched unrelated donor following the conditioning regimen: fludarabine/melphalan/anti-thymocyte globulin and a low dose of total body irradiation. Tacrolimus and a short course of methotrexate were used for graft-versus-host disease prophylaxis. Engraftment was achieved at day 12, and the patient maintained normal hematopoiesis for over 15 months after HSCT. We concluded that HSCT is a useful treatment for SCN patients, especially those who are at high risk for leukemic transformation. However, a larger number of SCN patients and longer follow-up are necessary to identify appropriate conditioning regimens and long-term prognosis.
我们报告了一名患有严重先天性中性粒细胞减少症(SCN)的4岁男孩,他通过造血干细胞移植(HSCT)获得了成功治疗。该患者自6个月大起就频繁发生细菌感染,在1岁4个月时中性粒细胞严重减少至低于100/μl。患者ELANE外显子3存在杂合错义突变(p.Q73P,g.2253 A>C)。这是一种新的新发突变,因此他被诊断为患有SCN。由于对粒细胞集落刺激因子治疗无反应且因细菌感染反复入院,在采用氟达拉滨/美法仑/抗胸腺细胞球蛋白和低剂量全身照射的预处理方案后,从血清学匹配的无关供体进行了异基因HSCT。使用他克莫司和短疗程甲氨蝶呤预防移植物抗宿主病。在第12天实现了植入,患者在HSCT后维持正常造血超过15个月。我们得出结论,HSCT是SCN患者的一种有效治疗方法,尤其是那些有白血病转化高风险的患者。然而,需要更多的SCN患者和更长时间的随访来确定合适的预处理方案和长期预后。