Fujimi Akihito, Kamihara Yusuke, Hashimoto Akari, Kanisawa Yuji, Nakajima Chisa, Hayasaka Naotaka, Yamada Shota, Okuda Toshinori, Minami Shinya, Ono Kaoru, Iyama Satoshi, Kato Junji
Department of Hematology and Oncology, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai City, 053-8506, Japan.
Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan.
Int J Hematol. 2015 Oct;102(4):471-6. doi: 10.1007/s12185-015-1806-0. Epub 2015 May 13.
A 55-year-old female with stage IVA follicular lymphoma in third complete remission underwent allogeneic peripheral blood stem cell transplantation. Neutrophil engraftment was achieved on day +18; however, platelet counts remained below 10 × 10(3)/µL, necessitating transfusions twice a week for more than 3 months. Bone marrow showed a decreased number of megakaryocytes with hypolobulated nuclei. No graft versus host disease, viral infection, or disease relapse was observed. Furthermore, severe thrombocytopenia below 5.0 × 10(3)/µL refractory to transfusion appeared on day +240 after influenza virus infection. Treatments with intravenous immunoglobulin, romiplostim, and rituximab were administered without any recovery. Subsequently, eltrombopag was initiated on day +443, after which platelet counts rose gradually and continued to rise above 20 × 10(3)/µL after 10 weeks of administration. The serum thrombopoietin (TPO) level was markedly elevated, and anti-TPO receptor (TPOR) antibody was detected in the patient's serum. Anti-TPOR antibody may play an important role in some cases of prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation with unknown etiology, and eltrombopag could be a novel therapeutic option for such cases.
一名处于第四次完全缓解期的IVA期滤泡性淋巴瘤55岁女性接受了异基因外周血干细胞移植。中性粒细胞在+18天实现植入；然而，血小板计数持续低于10×10(3)/µL，在3个多月的时间里每周需要输血两次。骨髓显示巨核细胞数量减少，细胞核分叶过少。未观察到移植物抗宿主病、病毒感染或疾病复发。此外，在感染流感病毒后第+240天出现了对输血难治的严重血小板减少，低于5.0×10(3)/µL。给予静脉注射免疫球蛋白、罗米司亭和利妥昔单抗治疗后血小板未恢复。随后，在第+443天开始使用艾曲泊帕，此后血小板计数逐渐上升，给药10周后持续升至20×10(3)/µL以上。血清血小板生成素（TPO）水平显著升高，且在患者血清中检测到抗血小板生成素受体（TPOR）抗体。抗TPOR抗体可能在某些病因不明的异基因造血干细胞移植后血小板减少持续时间较长的病例中起重要作用，而艾曲泊帕可能是这类病例的一种新的治疗选择。
