异基因造血干细胞移植后自身免疫性溶血性贫血一例并文献复习

Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation： report of one case and review of literature

目的总结异基因造血干细胞移植（allo-HSCT）后自身免疫性溶血性贫血（AIHA）的临床特征和诊治经验。方法分析苏州大学附属第一医院血液科收治的1例allo-HSCT后发生AIHA患者的临床资料，并进行文献复习。结果1例青年男性重型再生障碍性贫血患者在接受单倍体allo-HSCT近2年后，无诱因下发生AIHA，经糖皮质激素、静脉注射用丙种球蛋白、血浆置换术联合抗CD20单抗治疗后痊愈。文献复习显示，allo-HSCT后AIHA患者对含利妥昔单抗的治疗方案反应率相对较高，成年人及基础疾病为恶性病的allo-HSCT后AIHA患者病死率高，患者对利妥昔单抗反应不佳是预后差的最大危险因素。结论allo-HSCT后发生的AIHA对激素不敏感，治疗反应率低，是导致allo-HSCT患者病死率升高的危险因素。

Objective To summarize the clinical characteristics and treatment experiences of autoimmune hemolytic anemia （AIHA） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical data of the patient with AIHA after allogeneic HSCT in Hematology Department of the First Affiliated Hospital of Soochow University was analyzed, and the literatures were reviewed. Results After receiving 2 years of allo-HSCT, one young male patient with severe aplastic anemia showed AIHA in the absence of obvious incentives. The patient healed with the treatments of glucocorticoid, intravenous injection of gamma globulin, plasma exchange combined with injection of CD20 monoclonal antibody. Through the literature review, it showed that AIHA patients after HSCT had a good response to regimens containing rituximab, while adult and malignant patients with post-HSCT AIHA had a higher mortality. Poor response to rituximab was one of the greatest risk factors for poor prognosis. Conclusion AIHA is not sensitive to hormone with a low treatment response, which is a risk factor for the increased mortality of allo-HSCT patients.