二次半相合造血干细胞移植治疗重型再生障碍性贫血1例

Second haploidentical hematopoietic stem cell transplantation in a severe aplastic anemia patient with failed first transplantation

目的总结1例二次半相合造血干细胞移植治疗重型再生障碍性贫血的经验。方法回顾解放军总医院第一附属医院2015年收治的重型再生障碍性贫血1例,结合文献分析,总结其治疗经验。结果患者男性,45岁,主因"视物模糊1个月"入院,血常规、骨髓穿刺诊断急性重型再生障碍性贫血,首次造血干细胞移植供者为7/10相合同胞妹妹,+10 d白细胞植入,+26 d发热后出现移植排斥;首次移植48 d后行二次移植,供者为5/10相合女儿,+12 d白细胞、血小板植入,+39 d出现皮肤移植物抗宿主病,甲泼尼龙治疗后好转,+52 d出院。结论首次半相合造血干细胞移植治疗重型再生障碍性贫血失败后,仍可选择半相合供者进行二次移植。

Objective To summarize the experience of treating a severe aplastic anemia（SAA） patient with second haploidentical hematopoietic stem cell transplantation. Methods Clinical data about a severe aplastic anemia patient were analyzed and related literatures were reviewed to summarize its treating experience. Results A 45-year-old male who complained of blurred vision admitted to our department in 2015 with blood test and bone marrow biopsy showing acute severe aplastic anemia. We carried out a hematopoietic stem cell transplantation with his identical sibling sister（7/10 matched）, and leukocytes was implanted on day ＋10, while he got a fever on day ＋26 resulting from graft rejection. The second transplantation was carried out at 48 days after the first transplantation with his daughter（5/10 matched）. Leukocytes and platelets were implanted on day ＋12. The patient suffered from skin GVHD on day ＋39 which was cured after 5 days of methylprednisolone treatment, and he was discharged at 52 days after second transplantation. Conclusion For patient with SAA, if the first haploidentical hematopoietic stem cell transplantation has failed, second haploidentical transplantation is still a choice.