Nishio M, Sawada K, Koizumi K, Endoh T, Takashima H, Hashimoto H, Haseyama Y, Katagiri E, Fukada Y, Takano H, Tarumi T, Yasukouchi T, Koike T
Department of Internal Medicine II, Hokkaido University School of Medicine.
Rinsho Ketsueki. 1998 Aug;39(8):580-5.
A 35-year-old man with non-Hodgkin's lymphoma (NHL) (follicular small cleaved, B cell, stage IVB) received double myeloablative chemotherapy with syngeneic peripheral blood stem cell transplantation (PBSCT). Although platelet recovery was delayed until day 29 after the second transplantation, thereafter trilineage hematopoietic reconstitution was achieved. The evaluation after PBSCT did not detect any residual tumor. The patient was in good health until day 138, when his platelet count suddenly began falling; on day 150, it had fallen to 1.5 x 10(4)/microliter, and the patient was re-admitted for treatment. The bone marrow was normocellular with a normal count and megakaryocyte structure. Other examinations, including serological tests and computed tomography of the neck, chest, abdomen, and retroperitoneum, did not indicate a recurrence of NHL or reveal the cause of thrombocytopenia. The patient's platelet-associated IgG (PAIgG) level was at 70.9 ng/10(7) platelets (normal range: 9-25 ng/10(7) platelets); a diagnosis of thrombocytopenia due to an autoimmune mechanism such as idiopathic thrombocytopenic purpura (ITP) was made. Prednisolone therapy increased the platelet count and reduced the PAIgG level. Thrombocytopenia with an ITP-like mechanism rarely occurs more than 100 days after autologous or syngeneic stem cell transplantation, and should be taken into consideration as a late complication of PBSCT.
一名35岁的非霍奇金淋巴瘤（NHL）（滤泡性小裂细胞型，B细胞，IVB期）男性患者接受了同基因外周血干细胞移植（PBSCT）联合双次清髓性化疗。尽管血小板恢复延迟至第二次移植后第29天，但此后实现了三系造血重建。PBSCT后的评估未检测到任何残留肿瘤。患者一直健康状况良好，直到第138天，其血小板计数突然开始下降；在第150天，血小板计数降至1.5×10⁴/微升，患者再次入院接受治疗。骨髓细胞数量正常，计数及巨核细胞结构正常。包括血清学检查以及颈部、胸部、腹部和腹膜后的计算机断层扫描在内的其他检查，均未提示NHL复发或揭示血小板减少的原因。患者的血小板相关IgG（PAIgG）水平为70.9 ng/10⁷血小板（正常范围：9 - 25 ng/10⁷血小板）；诊断为因自身免疫机制如特发性血小板减少性紫癜（ITP）导致的血小板减少。泼尼松龙治疗使血小板计数升高，PAIgG水平降低。自体或同基因干细胞移植后100天以上很少发生类似ITP机制的血小板减少，应将其视为PBSCT的晚期并发症。
