异基因造血干细胞移植术后并发弥散性肺泡出血2例并文献复习

Two cases of diffuse alveolar hemorrhage following allogeneic hematopoietic stem cell transplantation and literature review

近年来,随着预处理方案的改进和新型免疫抑制剂的广泛应用,异基因造血干细胞移植（allo-HSCT）成功率取得很大提高,但肺部并发症仍然是allo-HSCT后患者的严重威胁,特别是对于接受清髓预处理的患者〔1〕。本文报告2例allo-HSCT后并发弥漫性肺泡出血（DAH）患者,通过对其临床特点进行分析并结合相关文献复习,以期提高临床对allo-HSCT后DAH的发病机制和治疗策略的认识。

Two patients diagnosed with acute lymphoblastic leukemia occurred diffuse alveolar hemorrhage（DAH） after they accepted the sib allogeneic hematopoietic stem cell transplantation（allo-HSCT）.The main clinical presentations were the progressive dyspnea,hypoxemia and hemoptysis.Radiological data confirmed the presence of DAH,and there was no clear evidence of pathogens.One of them achieved standard doses of corticosteroids treatment,the symptoms were complete relieved and lung lesions gradually absorbed.The other was progressive hypoaxemia,then developed respiratory failure and required mechanical ventilation support,though given large doses of corticosteroids and anti-CD25 monoclonal antibody therapy,the condition was improved in short time,and eventually developed to multiple organ failure and death.DAH following allo-HSCT was a non-infectious lung complication.At present,there is no definite guideline of treatment.