Ahmed Ibrahim, Teruya Jun, Murray-Krezan Cristina, Krance Robert
Department of Pediatric Hematology/Oncology and BMT, Children's Mercy Hospital, Kansas City, MO, USA.
Pediatr Transplant. 2015 Jun;19(4):391-8. doi: 10.1111/petr.12455. Epub 2015 Mar 23.
The reported incidence of post-allogeneic HSCT AIHA was between 4.4% and 6% following a single transplant. Cord blood transplantation, T-cell depletion, and chronic GvHD are significantly associated with post-transplant AIHA. During an 11-yr period, data for 500 pediatric HSCT recipients were eligible for evaluation of the incidence of AIHA post-first and post-second transplants. Demographic, transplant, and post-transplant-related variables were analyzed. Twelve of 500 (2.4%) recipients at a median of 273 days and seven of 72 (9.7%) recipients at a median of 157 days developed AIHA post-first and post-second HSCT, respectively. Post-first HSCT, none of the MRD recipients developed AIHA (0/175 MRD vs. 12/325 other donors, p = 0.04). Four of 12 required a second HSCT to control the AIHA. After the second HSCT, MUD was significantly associated with the development of AIHA. No other variables were associated with the post-second transplant AIHA. The incidence of AIHA post-first and post-second HSCT was less than the reported. The increased incidence of AIHA among recipients of second HSCT is most likely due to the profound immune dysregulation. A much larger, prospective study would be needed to evaluate the incidence, complications, and management of post-transplant AIHA.
据报道，单次异基因造血干细胞移植（HSCT）后自身免疫性溶血性贫血（AIHA）的发生率在4.4%至6%之间。脐带血移植、T细胞清除和慢性移植物抗宿主病（GvHD）与移植后AIHA显著相关。在11年期间，500名儿科HSCT受者的数据符合评估首次和第二次移植后AIHA发生率的条件。对人口统计学、移植及移植后相关变量进行了分析。500名受者中有12名（2.4%）在首次HSCT后发生AIHA，中位时间为273天；72名受者中有7名（9.7%）在第二次HSCT后发生AIHA，中位时间为157天。首次HSCT后，微小残留病（MRD）受者中无人发生AIHA（175名MRD受者中有0例 vs. 325名其他供者中有12例，p = 0.04）。12名患者中有4名需要进行第二次HSCT以控制AIHA。第二次HSCT后，非血缘供者（MUD）与AIHA的发生显著相关。没有其他变量与第二次移植后AIHA相关。首次和第二次HSCT后AIHA的发生率低于报道值。第二次HSCT受者中AIHA发生率增加很可能是由于严重的免疫失调。需要进行一项规模大得多的前瞻性研究来评估移植后AIHA的发生率、并发症及处理。
