Tichelli A, Gratwohl A, Nissen C, Würsch A, Signer E, Speck B
Departement für Innere Medizin, Kantonsspital, Basel.
Schweiz Med Wochenschr. 1988 Oct 22;118(42):1528-32.
Of 145 patients with severe aplastic anemia (SAA) treated in Basel from 1976 to 1987, 34 underwent bone marrow transplantation (BMT) and 111 received ALG therapy. We have analyzed the incidence of late complications in both groups of patients. 34 patients treated with ALG developed a hematological complication, 10 a myelodysplastic syndrome (MDS) and 18 paroxysmal nocturnal hemoglobinuria (PNH) associated with clinical symptoms in 12. Two patients had both MDS and PNH. Eight suffered relapse of SAA. After BMT neither of these complications occurred. Most of the non-hematological problems were associated with therapy. In the ALG group androgens were responsible for impotence and gynecomastia in men, deep voice in women and liver tumors in 4 patients. Four other patients developed aseptic necrosis of the hip and one carcinoma of the breast. The most severe late complication after BMT was chronic graft-versus-host disease (GvHD), occurring in patients still receiving methotrexate for prophylaxis of GvHD.
1976年至1987年在巴塞尔接受治疗的145例重型再生障碍性贫血（SAA）患者中，34例接受了骨髓移植（BMT），111例接受了抗淋巴细胞球蛋白（ALG）治疗。我们分析了两组患者晚期并发症的发生率。接受ALG治疗的34例患者出现血液学并发症，10例发生骨髓增生异常综合征（MDS），18例发生阵发性夜间血红蛋白尿（PNH），其中12例伴有临床症状。2例患者同时患有MDS和PNH。8例SAA复发。BMT后未出现这些并发症。大多数非血液学问题与治疗有关。在ALG组中，雄激素导致男性阳痿和乳腺增生、女性声音低沉以及4例患者发生肝肿瘤。另外4例患者出现髋关节无菌性坏死，1例发生乳腺癌。BMT后最严重的晚期并发症是慢性移植物抗宿主病（GvHD），发生在仍接受甲氨蝶呤预防GvHD的患者中。
