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[携带新型ELANE突变的严重先天性中性粒细胞减少症患者异体造血干细胞移植治疗成功]

[Successful treatment with allogenic hematopoietic stem cell transplantation of a severe congenital neutropenia patient harboring a novel ELANE mutation].

作者信息

Kawaguch Koji, Matsubara Kousaku, Uchida Yoshiko, Saito Atsuro, Miyata Kenji, Hasegawa Daiichiro, Kosaka Yoshiyuki, Iwata Aya, Nigami Hiroyuki, Kobayashi Masao

机构信息

Department of Pediatrics, Nishi-Kobe Medical Center.

出版信息

Rinsho Ketsueki. 2014 Nov;55(11):2294-9.

PMID:25501410
Abstract

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.

摘要

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。

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引用本文的文献

1
HSCT may lower leukemia risk in ELANE neutropenia: a before-after study from the French Severe Congenital Neutropenia Registry.HSCT 可能降低 ELANE 中性粒细胞减少症的白血病风险:来自法国严重先天性中性粒细胞减少症登记处的前后研究。
Bone Marrow Transplant. 2020 Aug;55(8):1614-1622. doi: 10.1038/s41409-020-0800-1. Epub 2020 Jan 28.
2
Elastase inhibitors as potential therapies for -associated neutropenia.弹性蛋白酶抑制剂作为治疗相关性中性粒细胞减少症的潜在疗法。
J Leukoc Biol. 2017 Oct;102(4):1143-1151. doi: 10.1189/jlb.5A1016-445R. Epub 2017 Jul 28.
3
Allogeneic Transplant in ELANE and MEFV Mutation Positive Severe Cyclic Neutropenia: Review of Prognostic Factors for Secondary Severe Events.
ELANE和MEFV突变阳性的严重周期性中性粒细胞减少症的异基因移植:继发性严重事件的预后因素综述
Case Rep Hematol. 2017;2017:5375793. doi: 10.1155/2017/5375793. Epub 2017 Jan 18.