摘要
目的探讨输血相关移植物抗宿主病(TA-GVHD)的临床表现、诊断标准,与氟达拉滨治疗的相关性及预防措施。方法回顾总结2例接受氟达拉滨化疗的慢性淋巴细胞白血病(CLL)/小淋巴细胞淋巴瘤(SLL)患者的临床资料,化疗后出现TA-GVHD的临床表现、治疗及转归,并复习相关文献。结果 2例患者化疗前后间断多次输血,均出现发热、广泛性充血性斑疹,不可逆性血细胞减少、肝功能异常,经糖皮质激素治疗改善不明显,1例因严重肺部感染并呼吸衰竭自动出院,1例因严重口腔黏膜炎自动出院。结论接受氟达拉滨化疗的患者淋巴细胞增殖受抑时间长,存在免疫缺陷,输入含免疫活性淋巴细胞的血制品后极易发生TA-GVHD。TA-GVHD可累及多个脏器,最终因多器官衰竭或全血细胞减少并发严重出血和感染而死亡。通过辐照血制品灭活或除去免疫活性的淋巴细胞可以预防TA-GVHD的发生。
Objective To investigate the manifestations,diagnosis,preventive measure of transfusion-associated graft-versus-host disease（TA-GVHD）,and the relationship between TA-GVHD and fludarabine.Methods Clinical data of two chronic lymphatic leukemia（CLL）/ small lymphocytic lymphoma（SLL）patients including the manifestations,treatment and prognosis were investigated.The relevant literatures were reviewed.Results Both patients appeared high fever,extensive congestive macula,inconvertible pancytopenia,hepatic lesion after transfusion,and still aggravated after glucocorticosteroid therapy,and gave up therapy because of severe complication,including oral mucosa inflammation,pulmonary infection and respiratory failure.Conclusion Patients treated with fludarabine appear to be at risk for TA-GVHD because their lymphatic system and immune function will be restrainted for a long time,and easily develop GVHD after transfusion with blood products containing active lymphocytes.TA-GVHD will aggravate quickly and result in multiple organ failure or sever infection and haemorrhage.Irradiating blood products before transfusion will be an effective measure to prevent TA-GVHD.
出处
《福建医药杂志》
CAS
2011年第3期17-21,共5页
Fujian Medical Journal
关键词
氟达拉滨
输血相关移植物抗宿主病
免疫缺陷
预防
Fludarabine
transfusion-associated graft-versus-host disease
immune deficiency
preventive measure
