Ikeda M, Tsukada N, Chikai H, Tasaki M, Saito K, Nakagawa Y, Takahashi K, Suzuki K
Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
Transplant Proc. 2016 Nov;48(9):3085-3087. doi: 10.1016/j.transproceed.2016.03.033.
There have been few reports on allogeneic stem cell transplantation in patients who have previously undergone solid organ transplantation. The clinical course of such patients is not yet well recognized. Therefore, appropriate immunosuppressive prophylaxis for the rejection of a solid organ graft or for graft-versus-host disease has not yet been established. We present the case of a successful allogeneic stem cell transplantation in a patient who relapsed after a first allogeneic stem cell transplantation for myelodysplastic syndrome and who had previously undergone renal transplantation. The prophylaxis in this case for graft-versus-host disease and rejection of the transplanted kidney was mycophenolate mofetil and tacrolimus. No hyperacute rejection of the transplanted kidney was observed. However, the patient's renal function deteriorated after the cessation of the mycophenolate mofetil and the reduction of the tacrolimus. This deterioration seemed to be due to rejection with humoral immunity of donor lymphocytes, and we were able to control it by resuming the mycophenolate mofetil and local graft irradiation.
此前接受过实体器官移植的患者进行异基因干细胞移植的报道较少。这类患者的临床病程尚未得到充分认识。因此，针对实体器官移植物排斥或移植物抗宿主病的适当免疫抑制预防措施尚未确立。我们报告了1例成功进行异基因干细胞移植的病例，该患者在首次因骨髓增生异常综合征接受异基因干细胞移植后复发，且此前接受过肾移植。该病例中针对移植物抗宿主病和移植肾排斥的预防措施是使用霉酚酸酯和他克莫司。未观察到移植肾的超急性排斥反应。然而，在停用霉酚酸酯并减少他克莫司剂量后，患者的肾功能恶化。这种恶化似乎是由于供体淋巴细胞的体液免疫排斥反应所致，我们通过恢复使用霉酚酸酯和局部移植物照射成功控制了病情。
