Trede N S, Warwick A B, Rosoff P M, Rohrer R, Bierer B E, Guinan E
Department of Pediatric Oncology, Dana Farber Cancer Institute, and Children's Hospital, Boston, MA 02115, USA.
Bone Marrow Transplant. 1997 Aug;20(3):257-60. doi: 10.1038/sj.bmt.1700872.
Severe aplastic anemia (SAA) is a frequent complication of orthotopic liver transplantation for non-typeable viral hepatitis. Allogeneic bone marrow transplantation (BMT) may successfully reconstitute hematopoiesis but the optimal conditioning regimen and graft-versus-host disease (GVHD) prophylaxis in such patients are unknown. Allogeneic BMT was undertaken in an 8-year-old male patient who developed SAA 6 weeks after cadaveric orthotopic liver transplantation for fulminant hepatic failure secondary to presumed non-typeable viral hepatitis. The preparative regimen for his HLA genotypically identical sibling BMT consisted of cytoxan and anti-thymocyte globulin. Tacrolimus (FK506) and prednisone, used to prevent liver graft rejection, were supplemented with methotrexate on post-BMT days, 1, 3, 6 and 11 for GVHD prophylaxis. Engraftment proceeded promptly and without complications. Transfusion dependence resolved 6 weeks after BMT. The patient is alive and well 1 year after his BMT on FK506 and prednisone without any signs of GVHD or liver allograft rejection. This case is the first demonstration of the feasibility of continuing FK506 used for prevention of liver graft rejection as GVHD prophylaxis for allogeneic BMT.
严重再生障碍性贫血（SAA）是不可分型病毒性肝炎原位肝移植的常见并发症。异基因骨髓移植（BMT）可成功重建造血功能，但此类患者的最佳预处理方案及移植物抗宿主病（GVHD）预防措施尚不清楚。一名8岁男性患者在因推测为不可分型病毒性肝炎导致的暴发性肝衰竭接受尸体原位肝移植6周后发生SAA，随后接受了异基因BMT。其与HLA基因型相同的同胞进行BMT的预处理方案包括环磷酰胺和抗胸腺细胞球蛋白。用于预防肝移植排斥反应的他克莫司（FK506）和泼尼松，在BMT后第1、3、6和11天补充甲氨蝶呤用于预防GVHD。造血迅速植入且无并发症。BMT 6周后输血依赖消失。该患者在接受BMT 1年后，使用FK506和泼尼松存活良好，无任何GVHD或肝移植排斥反应迹象。该病例首次证明了将用于预防肝移植排斥反应的FK506继续用作异基因BMT的GVHD预防措施的可行性。
