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目的探讨主要ABO血型不合非清髓性异基因外周血干细胞移植(NST)后纯红细胞再生障碍性贫血(PRCA)发生的机制及治疗对策。方法对1例非霍奇金淋巴瘤(NHL)和1例慢性粒细胞性白血病(CML)患者行NST治疗,2例患者血型均为O型,供体为HLA完全相合的同胞(血型均为A型)。结果2例患者NST获得成功,但分别于移植后2、3个月出现PRCA,经强的松、雄激素、大剂量丙种球蛋白、皮下注射重组人促红细胞生成素(EPO)治疗,PRCA均无明显的改善。2例患者停用环孢菌素A(CsA)后均发生慢性移植物抗宿主病(cGVHD),经普乐可复(FK506)免疫抑制治疗后,cGVHD控制,同时抗A凝集素很快下降至0,网织红细胞、血红蛋白上升。结论EPO、大剂量丙球对该组病例治疗无效。NST后一旦发生PRCA,应尽早停用CsA,cGVHD控制与PRCA的恢复相关。
Objective To investigate the mechanism and treatment of pure erythrocyte aplastic anemia (PRCA) after major non-myeloablative allogeneic peripheral blood stem cell transplantation (NST). Methods One patient with non-Hodgkin’s lymphoma (NHL) and one patient with chronic myelogenous leukemia (CML) underwent NST. The blood type of the two patients was O type, and the donors were HLA-identical siblings A type). Results Two patients had successful NST. PRCA occurred at two and three months after transplantation. The patients were treated with prednisone, androgen, high-dose gamma globulin, and subcutaneous injection of recombinant human erythropoietin (EPO) No significant improvement. Two patients developed chronic graft-versus-host disease (cGVHD) after discontinuation of cyclosporine A (CsA) and were controlled by cGVHD after immunosuppression with buprofezin (FK506), while anti-lectin decreased rapidly To 0, reticulocytes, hemoglobin increased. Conclusion EPO, high-dose corticosteroid treatment of this group of patients is invalid. Once PRCA occurs after NST, CsA should be discontinued as early as possible and cGVHD control associated with PRCA recovery.