Kim H J, Chung I J, Lee J J, Seo J S, Park M R, Choi K S, Kook H, Hwang T J
Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea.
Korean J Intern Med. 1998 Feb;13(1):60-3. doi: 10.3904/kjim.1998.13.1.60.
To overcome poor graft function after allogeneic bone marrow transplantation (BMT), the use of peripheral blood stem cells (PBSC) instead of bone marrow is gaining more popularity because of its advantages. There may, however, be an increased risk of graft-versus-host-disease (GVHD) because of the large number of lymphocytes present in a leukapheresis product. An 18-year-old man with severe aplastic anemia underwent an allogeneic BMT using his HLA-identical sister. After initial excellent graft take for 8 months, his blood counts gradually decreased to 2.8 x 10(9)/L of white cells and 28 x 10(9)/L of platelets with marrow cellularity of < 10%. After allogeneic granulocyte-colony stimulating factor mobilized PBSC rescue, the patient's blood counts recovered satisfactorily. Around 1 year after the boost, he developed chronic GVHD that responded to prednisolone and cyclosporin A. He is now well on low-dose steroids at day +1055 after PBSC rescue. The present case is the first experience of a long-term follow-up who underwent allogeneic PBSC rescue in Korea.
为克服异基因骨髓移植（BMT）后移植物功能不佳的问题，由于外周血干细胞（PBSC）具有优势，使用外周血干细胞而非骨髓正变得越来越普遍。然而，由于白细胞分离产品中存在大量淋巴细胞，移植物抗宿主病（GVHD）的风险可能会增加。一名18岁的重度再生障碍性贫血男性患者接受了来自其 HLA 匹配的姐姐的异基因BMT。在最初8个月移植物良好植入后，他的血细胞计数逐渐下降至白细胞2.8×10⁹/L，血小板28×10⁹/L，骨髓细胞密度<10%。在异基因粒细胞集落刺激因子动员的PBSC救援后，患者的血细胞计数令人满意地恢复。在强化治疗约1年后，他出现了慢性GVHD，对泼尼松龙和环孢素A有反应。在PBSC救援后第1055天，他现在使用低剂量类固醇情况良好。本病例是韩国首例接受异基因PBSC救援并进行长期随访的经验。
