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伊布替尼治疗造血干细胞移植后自身免疫性血细胞减少2例报告并文献复习
Ibrutinib for treatment of autoimmune cytopenia after hematopoietic stem cell transplantation: report of 2 cases and literature review
- 第三军医大学学报 2021年43卷第21期 页码：2337-2342
- 作者机构：
430030 武汉，华中科技大学同济医学院附属协和医院血液科
- 作者简介：
[仲照东，E-mail：whxhzzd008@126.com ZHONG Zhaodong, E-mail: whxhzzd008@126.com
- 基金信息：
DOI：10.16016/j.1000-5404.202108028
中图分类号： R556.62;R558.2;R973收稿：2021-08-05，
修回：2021-09-15，
纸质出版：2021-11-15
- 稿件说明：
移动端阅览
韦若文, 陈文兰, 谢荣, 等. 伊布替尼治疗造血干细胞移植后自身免疫性血细胞减少2例报告并文献复习[J]. 第三军医大学学报, 2021,43(21):2337-2342.
Ruowen WEI, Wenlan CHEN, Rong XIE, et al. Ibrutinib for treatment of autoimmune cytopenia after hematopoietic stem cell transplantation: report of 2 cases and literature review[J]. Journal of Third Military Medical University, 2021, 43(21): 2337-2342.
韦若文, 陈文兰, 谢荣, 等. 伊布替尼治疗造血干细胞移植后自身免疫性血细胞减少2例报告并文献复习[J]. 第三军医大学学报, 2021,43(21):2337-2342. DOI： 10.16016/j.1000-5404.202108028.
Ruowen WEI, Wenlan CHEN, Rong XIE, et al. Ibrutinib for treatment of autoimmune cytopenia after hematopoietic stem cell transplantation: report of 2 cases and literature review[J]. Journal of Third Military Medical University, 2021, 43(21): 2337-2342. DOI： 10.16016/j.1000-5404.202108028.
摘要
目的
2
初步探究伊布替尼治疗造血干细胞移植后自身免疫性血细胞减少(autoimmune cytopenia
AIC)的疗效。
方法
2
收集2016、2018年在本院行造血干细胞移植的白血病患者2例，移植后分别诊断为Evans综合征和纯红细胞再生障碍性贫血(pure red cell aplastic anemia，PRCA)，经糖皮质激素、人免疫球蛋白、免疫抑制剂、血浆置换、输血支持等治疗后效果不佳，给予伊布替尼治疗，观察疗效及免疫指标的变化。
结果
2
移植后出现PRCA的患者使用伊布替尼治疗后红细胞输注次数较前减少，抗供者血型抗体较前下降，血红蛋白逐步上升，治疗3个月后逐步脱离输血，随后获得完全缓解。移植后出现Evans综合征的患者使用伊布替尼治疗后约2周后脱离血小板输注，血红蛋白及血小板逐渐升高，直接抗球蛋白试验(DAT)逐步转为弱阳性，自身抗体逐渐转阴，获得完全缓解。2例患者均未出现明显药物副反应或原发病复发。
结论
2
伊布替尼治疗造血干细胞移植术后PRCA或Evans综合征有一定疗效。
Abstract
Objective
2
To explore the curative effect of ibrutinib in treatment of autoimmune cytopenia (AIC) after hematopoietic stem cell transplantation (HSCT).
Methods
2
Two leukemia patients receiving HSCT at our hospital in 2016 and 2018 respectively were enrolled in this study
who were subsequently diagnosed as Evans syndrome (case 2) and pure red cell aplastic Anemia (PRCA) (case 1) respectively after transplantation. Due to failing to the treatment of glucocorticoid
immunoglobulin
immunosuppressants
plasma exchange and blood transfusion support
ibrutinib was tentatively applied to the patients
and its therapeutic effects and the changes of immune indexes were observed.
Results
2
After ibrutinib treatment
case 1 needed fewer times of red blood cell transfusion than before
with decreased level of anti-donor blood group antibodies and gradually elevated hemoglobin level. She was gradually relieved of blood transfusion
and then achieved complete remission about 3 months after the treatment. As for case 2
she was released from platelet infusion approximately 2 weeks after the ibrutinib treatment
with progressively improved hemoglobin level and platelet count
got weakly positive result to direct antiglobulin test (DAT) and negative result to autoantibodies
and achieved complete remission as well. No obvious adverse drug reactions or recurrence of primary disease were observed in the 2 patients.
Conclusion
2
Ibrutinib has certain efficacy in the treatment for PRCA or Evans syndrome after HSCT.
关键词
Keywords
references
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