摘要
纯红细胞再生障碍性贫血是ABO血型不合的异基因造血干细胞移植后常见的并发症。治疗该并发症有多种方法可供选择,包括大剂量激素、促红细胞生成素、血浆置换、免疫吸附、供者淋巴细胞输注、利妥昔单抗、硼替佐米、达雷木单抗以及减停免疫抑制剂等。在本文中,我们呈现了一个ABO血型不合的异基因造血干细胞移植后出现纯红细胞再生障碍性贫血的病例。重组人促红细胞生成素、糖皮质激素、供着淋巴细胞输注、血浆置换以及减停免疫抑制剂等方法均对其无明显疗效,最终在足剂量长疗程的艾曲波帕治疗下,患者得以康复。通过对艾曲波帕在治疗纯红细胞再生障碍性贫血中的机制的推测,我们发现艾曲波帕可能对单系造血有效,并且可被用于ABO不合的异基因造血干细胞移植后纯红细胞再生障碍性贫血的治疗。
This is a preview of subscription content, log in via an institution to check access.
References
Alvarado LJ, Huntsman HD, Cheng H, et al., 2019. Eltrombopag maintains human hematopoietic stem and progenitor cells under inflammatory conditions mediated by IFN-γ. Blood, 133(19):2043–2055. https://doi.org/10.1182/blood-2018-11-884486
Bao WL, Bussel JB, Heck S, et al., 2010. Improved regulatory T-cell activity in patients with chronic immune thrombocytopenia treated with thrombopoietic agents. Blood, 116(22):4639–4645. https://doi.org/10.1182/blood-2010-04-281717
Bathini S, Holtzman NG, Koka R, et al., 2019. Refractory postallogeneic stem cell transplant pure red cell aplasia in remission after treatment with daratumumab. Am J Hematol, 94(8):E216–E219. https://doi.org/10.1002/ajh.25515
Busca A, Dellacasa C, Giaccone L, et al., 2018. Eltrombopag for the treatment of refractory pure RBC aplasia after major ABO incompatible hematopoietic stem cell transplantation. Biol Blood Marrow Transplant, 24(8):1765–1770. https://doi.org/10.1016/j.bbmt.2018.04.022
Desmond R, Townsley DM, Dumitriu B, et al., 2014. Eltrombopag restores trilineage hematopoiesis in refractory severe aplastic anemia that can be sustained on discontinuation of drug. Blood, 123(12):1818–1825. https://doi.org/10.1182/blood-2013-10-534743
Gao F, Zhou XY, Shi JM, et al., 2020. Eltrombopag treatment promotes platelet recovery and reduces platelet transfusion for patients with post-transplantation thrombocytopenia. Ann Hematol, 99(11):2679–2687. https://doi.org/10.1007/s00277-020-04106-2
Guenther KL, Cheruku PS, Cash A, et al., 2019. Eltrombopag promotes DNA repair in human hematopoietic stem and progenitor cells. Exp Hematol, 73:1–6.e6. https://doi.org/10.1016/j.exphem.2019.03.002
Hirokawa M, Fukuda T, Ohashi K, et al., 2013. Efficacy and long-term outcome of treatment for pure red cell aplasia after allogeneic stem cell transplantation from major ABO-incompatible donors. Biol Blood Marrow Transplant, 19(7):1026–1032. https://doi.org/10.1016/j.bbmt.2013.04.004
Olnes MJ, Scheinberg P, Calvo KR, et al., 2012. Eltrombopag and improved hematopoiesis in refractory aplastic anemia. N Engl J Med, 367(1):11–19. https://doi.org/10.1056/NEJMoa1200931
Sackett K, Cohn CS, Fahey-Ahrndt K, et al., 2018. Successful treatment of pure red cell aplasia because of ABO major mismatched stem cell transplant. J Clin Apher, 33(1):108–112. https://doi.org/10.1002/jca.21553
Selleri C, Raiola A, de Rosa G, et al., 1998. CD34+-enriched donor lymphocyte infusions in a case of pure red cell aplasia and late graft failure after major ABO-incompatible bone marrow transplantation. Bone Marrow Transplant, 22(6):605–607. https://doi.org/10.1038/sj.bmt.1701384
Shahan JL, Hildebrandt GC, 2015. Successful treatment of refractory pure red cell aplasia with bortezomib after allogeneic haematopoietic cell transplantation in a patient with alpha-beta subcutaneous panniculitis-like T cell lymphoma. Transfus Med, 25(5):342–344. https://doi.org/10.1111/tme.12216
Vlachodimitropoulou E, Chen YL, Garbowski M, et al., 2017. Eltrombopag: a powerful chelator of cellular or extracellular iron(III) alone or combined with a second chelator. Blood, 130(17):1923–1933. https://doi.org/10.1182/blood-2016-10-740241
Yang X, Levis M, 2014. Pulsed-high-dose dexamethasone as a treatment for pure red cell aplasia following ABO-incompatible allogeneic stem cell transplantation. Transfus Med, 24(4):246–248. https://doi.org/10.1111/tme.12143
Zhao Z, Sun Q, Sokoll LJ, et al., 2018. Eltrombopag mobilizes iron in patients with aplastic anemia. Blood, 131(21):2399–2402. https://doi.org/10.1182/blood-2018-01-826784
Zhidong W, Hongmin Y, Hengxiang W, 2012. Successful treatment of pure red cell aplasia with a single low dose of rituximab in two patients after major ABO incompatible peripheral blood allogeneic stem cell transplantation. Transfus Med, 22(4):302–304. https://doi.org/10.1111/j.1365-3148.2012.01156.x
Acknowledgments
This work was supported by the National Natural Science Foundation of China (No. 81670148) and the Health Science and Technology Project of Zhejiang Province (No. 2012KYB079), China.
Author information
Authors and Affiliations
Contributions
Yang GAO contributed to reviewing the patient and writing the manuscript. Fei GAO wrote part of the manuscript and reviewed the literature. Jimin SHI and Huarui FU supported the treatment course of the patient, and provided their comments on this manuscript. He HUANG and Yanmin ZHAO were mainly in charge of the patient, and critically reviewed the patient and the manuscript. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
Corresponding authors
Additional information
Compliance with ethics guidelines
Yang GAO, Fei GAO, Jimin SHI, Huarui FU, He HUANG, and Yanmin ZHAO declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from the patient for being included in the report.
Rights and permissions
About this article
Cite this article
Gao, Y., Gao, F., Shi, J. et al. Successful treatment of refractory pure red cell aplasia with eltrombopag after ABO-incompatible allogeneic hematopoietic stem cell transplantation. J. Zhejiang Univ. Sci. B 22, 695–700 (2021). https://doi.org/10.1631/jzus.B2000532
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1631/jzus.B2000532