nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2014-0-1-75-79nodgo-17Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL CASESИммунный гемолиз у больного после повторной трансплантации гемопоэтических стволовых клеток:клинический случай и обзор литературыImmune haemolysis in a patient after haematopoietic stem cell retransplantation: case report and a literature reviewОбразцовИгорь ВладимировичObraztsovI. V.

Москва

Moscow

igor_obraztsov@bk.ruВасильеваА. П.VasilievaA. P.

Москва

Moscow

igor_obraztsov@bk.ruФГБУ ФНКЦ ДГОИ им. Дмитрия Рогачева Минздрава РоссииРоссияFederal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of RussiaRussian Federation201431032015017579Copyright © Образцов И.В., Васильева А.П., 20152015Образцов И.В., Васильева А.П.Obraztsov I.V., Vasilieva A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/17

Гемолитическая анемия является серьезным, угрожающим жизни осложнением трансплантации гемопоэтических стволовых клеток (ТГСК), развивающимся в результате продукции антиэритроцитарных антител как алло-, так и аутоиммунной природы. В отличие от аллоиммунной гемолитической анемии, механизмы развития аутоиммунного гемолиза в посттрансплантационном периоде до сих пор изучены недостаточно. Этим объясняется отсутствие стандартизованных протоколов лечения случаев рефрактерного течения и упорных рецидивов гемолитической анемии. В работе представлен разбор клинического случая рефрактерного аутоиммунного гемолиза у ребенка с ювенильным миеломоноцитарным лейкозом после повторной ТГСК, а такжеобзор современных подходов к классификации, диагностике и терапии иммунного гемолиза у посттрансплантационных пациентов.

 

Haemolytic anaemia is a serious life-threatening complication that follows haematopoietic stem cell transplantation (HSCT) as a result of allo- or autoimmune derived anti-erythrocyte antibodies production. Unlike alloimmune haemolytic anaemia, mechanisms of autoimmune haemolysis in posttransplant period are poorly understood that explains the lack of standardized protocols for treatment of refractory or recurrent cases. We present here a report of a case of refractory autoimmune haemolysis in a patient with juvenile myelomonocytic leukemia after re-HSCT, as well as a review of current approaches to classification, diagnosis and therapy of immune haemolysis in posttransplant patients.

 

 

гемолизтрансплантация гемопоэтических стволовых клетокювенильный миеломоноцитарный лейкозциклофосфамидритуксимаббортезомибэкулизумабhaemolysishaematopoietic stem cell transplantationjuvenile myelomonocytic leukemiacyclophosphamiderituximabbortezomibeculizumabReferencesAlba P., Karim M. Y., Hunt B. J. Mycophenolate mofetil as a treatment for autoimmune haemolytic anaemia in patients with systemic lupus erythematosus and antiphospholipid syndrome. Lupus 2003;12 (8):633–5.Alba P., Karim M. Y., Hunt B. J. Mycophenolate mofetil as a treatment for autoimmune haemolytic anaemia in patients with systemic lupus erythematosus and antiphospholipid syndrome. Lupus 2003;12 (8):633–5.Bass G. F., Tuscano E. T., Tuscano J. M. Diagnosis and classification of autoimmune hemolytic anemia. Autoimmun Rev 2014;13(4–5):560–4.Bass G. F., Tuscano E. T., Tuscano J. M. Diagnosis and classification of autoimmune hemolytic anemia. Autoimmun Rev 2014;13(4–5):560–4.Baudino L., Nimmerjahn F., Azeredo da Silveira S. et al. Differential contribution of three activating IgG Fc receptors (FcgammaRI, FcgammaRIII, and FcgammaRIV) to IgG2a- and IgG2b-induced autoimmune hemolytic anemia in mice. J Immunol 2008;180(3):1948–53.Baudino L., Nimmerjahn F., Azeredo da Silveira S. et al. Differential contribution of three activating IgG Fc receptors (FcgammaRI, FcgammaRIII, and FcgammaRIV) to IgG2a- and IgG2b-induced autoimmune hemolytic anemia in mice. J Immunol 2008;180(3):1948–53.Chen F. E., Owen I., Savage D. et al. Late onset haemolysis and red cell autoimmunisation after allogeneic bone marrow transplant. Bone Marrow Transplant 1997;19(5):491–5.Chen F. E., Owen I., Savage D. et al. Late onset haemolysis and red cell autoimmunisation after allogeneic bone marrow transplant. Bone Marrow Transplant 1997;19(5):491–5.Cheung W. W., Hwang G. Y., Tse E., Kwong Y. L. Alemtuzumab induced complete remission of autoimmune hemolytic anemia refractory to corticosteroids, splenectomy and rituximab. Haematologica 2006;91(5 Suppl):ECR13.Cheung W. W., Hwang G. Y., Tse E., Kwong Y. L. Alemtuzumab induced complete remission of autoimmune hemolytic anemia refractory to corticosteroids, splenectomy and rituximab. Haematologica 2006;91(5 Suppl):ECR13.Crowther M., Chan Y. T., Garbett I. K. et al. Evidence-based focused review of the treatment of idiopathic warm immune hemolytic anemia in adults. Blood 2011;118(15):4036–40.Crowther M., Chan Y. T., Garbett I. K. et al. Evidence-based focused review of the treatment of idiopathic warm immune hemolytic anemia in adults. Blood 2011;118(15):4036–40.Faraci M., Zecca M., Pillon M. et al. Autoimmune hematological diseases after allogeneic hematopoietic stem cell transplantation in children: an Italian multicenter experience. Biol Blood Marrow Transplant 2014;20(2):272–8.Faraci M., Zecca M., Pillon M. et al. Autoimmune hematological diseases after allogeneic hematopoietic stem cell transplantation in children: an Italian multicenter experience. Biol Blood Marrow Transplant 2014;20(2):272–8.Flores G., Cunningham-Rundles C., Newland A. C., Bussel J. B. Efficacy of intravenous immunoglobulin in the treatment of autoimmune hemolyticanemia; results in 73 patients. Am J Hematol 1993;44(4):237–42.Flores G., Cunningham-Rundles C., Newland A. C., Bussel J. B. Efficacy of intravenous immunoglobulin in the treatment of autoimmune hemolyticanemia; results in 73 patients. Am J Hematol 1993;44(4):237–42.Godder K., Pati A. R., Abhyankar S. H. et al. De novo chronic graft-versus-host disease presenting as hemolytic anemia following partially mismatched related donor bone marrow transplant. Bone Marrow Transplant 1997;19(8):813–7.Godder K., Pati A. R., Abhyankar S. H. et al. De novo chronic graft-versus-host disease presenting as hemolytic anemia following partially mismatched related donor bone marrow transplant. Bone Marrow Transplant 1997;19(8):813–7.Iuchi Y., Kibe N., Tsunoda S. et al. Implication of oxidative stress as a cause of autoimmune hemolytic anemia in NZB mice. Free Radic Biol Med 2010;48(7):935–44.Iuchi Y., Kibe N., Tsunoda S. et al. Implication of oxidative stress as a cause of autoimmune hemolytic anemia in NZB mice. Free Radic Biol Med 2010;48(7):935–44.Michel M. Classification and therapeutic approaches in autoimmune hemolytic anemia: an update. Expert Rev Hematol 2011;4(6):607–18.Michel M. Classification and therapeutic approaches in autoimmune hemolytic anemia: an update. Expert Rev Hematol 2011;4(6):607–18.O’Brien T. A., Eastlund T., Peters C. et al. Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in paediatric patients: high incidence and significant mortality in unrelated donor transplants for non-malignant diseases. Br J Haematol 2004;127(1):67–75.O’Brien T. A., Eastlund T., Peters C. et al. Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in paediatric patients: high incidence and significant mortality in unrelated donor transplants for non-malignant diseases. Br J Haematol 2004;127(1):67–75.O’Connell N., Goodyer M., Gleeson M. et al. Successful treatment with rituximab and mycophenolate mofetil of refractory autoimmune hemolytic anemia post-hematopoietic stem cell transplant for dyskeratosis congenita due to TINF2 mutation. Pediatr Transplant 2014;18(1):E22–4.O’Connell N., Goodyer M., Gleeson M. et al. Successful treatment with rituximab and mycophenolate mofetil of refractory autoimmune hemolytic anemia post-hematopoietic stem cell transplant for dyskeratosis congenita due to TINF2 mutation. Pediatr Transplant 2014;18(1):E22–4.Perez-Andres M., Paiva B., Nieto W. G. et al.; Primary Health Care Group of Salamanca for the Study of MBL. Human peripheral blood B-cell compartments: a crossroad in B-cell traffic. Cytometry B Clin Cytom 2010;78 Suppl 1:S47–60.Perez-Andres M., Paiva B., Nieto W. G. et al.; Primary Health Care Group of Salamanca for the Study of MBL. Human peripheral blood B-cell compartments: a crossroad in B-cell traffic. Cytometry B Clin Cytom 2010;78 Suppl 1:S47–60.Reddy P., Ferrara J. L. Immunobiology of acute graft-versus-host disease. Blood Rev 2003;17:187–94.Reddy P., Ferrara J. L. Immunobiology of acute graft-versus-host disease. Blood Rev 2003;17:187–94.Saha M., Ray S., Kundu S., Chakrabarti P. Pure red cell aplasia following autoimmune hemolytic anemia: an enigma. J Postgrad Med 2013;59(1):51–3.Saha M., Ray S., Kundu S., Chakrabarti P. Pure red cell aplasia following autoimmune hemolytic anemia: an enigma. J Postgrad Med 2013;59(1):51–3.Sanz J., Arriaga F., Montesinos P. et al. Autoimmune hemolyticanemia following allogeneic hematopoietic stem cell transplantation in adult patients. Bone Marrow Transplant 2007:39(9):555–61.Sanz J., Arriaga F., Montesinos P. et al. Autoimmune hemolyticanemia following allogeneic hematopoietic stem cell transplantation in adult patients. Bone Marrow Transplant 2007:39(9):555–61.Sevilla J., González-Vicent M., Madero L., Díaz M. A. Acute autoimmune hemolytic anemia following unrelated cord blood transplantation as an early manifestation of chronic graft-versus-host disease. Bone Marrow Transplant 2001;28(1):89–92.Sevilla J., González-Vicent M., Madero L., Díaz M. A. Acute autoimmune hemolytic anemia following unrelated cord blood transplantation as an early manifestation of chronic graft-versus-host disease. Bone Marrow Transplant 2001;28(1):89–92.Shlomchik W. D. Antigen presentation in graft-vs-host disease. Exp Hematol 2003;31(12):1187–97.Shlomchik W. D. Antigen presentation in graft-vs-host disease. Exp Hematol 2003;31(12):1187–97.Stussi G., Halter J., Schanz U., Seebach J. D. ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation. Transfus Apher Sci 2006;35(1):59–69.Stussi G., Halter J., Schanz U., Seebach J. D. ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation. Transfus Apher Sci 2006;35(1):59–69.Toriani-Terenzi C., Pozzetto U., Bianchi M., Fagiolo E. Cytokine network in autoimmune haemolytic anaemia: new probable targets for therapy. Cancer Detect Prev 2002;26(4):292–8.Toriani-Terenzi C., Pozzetto U., Bianchi M., Fagiolo E. Cytokine network in autoimmune haemolytic anaemia: new probable targets for therapy. Cancer Detect Prev 2002;26(4):292–8.Xu L., Zhang T., Liu Z. et al. Critical role of Th17 cells in development of autoimmune hemolytic anemia. Exp Hematol 2012;40(12):994–1004.Xu L., Zhang T., Liu Z. et al. Critical role of Th17 cells in development of autoimmune hemolytic anemia. Exp Hematol 2012;40(12):994–1004.Zecca M., Nobili B., Ramenghi U. et al. Rituximab for the treatment of refractory autoimmune hemolytic anemia in children. Blood 2003;101(10):3857–61.Zecca M., Nobili B., Ramenghi U. et al. Rituximab for the treatment of refractory autoimmune hemolytic anemia in children. Blood 2003;101(10):3857–61.

The authors declare that there are no conflicts of interest present.