Xin yixue (Mar 2024)
Treatment of acute graft-versus-host disease after umbilical cord blood transplantation under the guidance of immune monitoring： a case report and literature review
Abstract
Objective To explore the effect of the precise diagnosis and treatment of a case of acute graft-versus-host disease （aGVHD） with rash as the main manifestation under the guidance of immune monitoring. Methods Clinical data and diagnosis and treatment of a child with high-risk acute myeloid leukemia who developed intractable rash after receiving unrelated umbilical cord blood transplantation were retrospectively analyzed. Using the keywords of “hematopoietic stem cell transplantation”“immune reconstitution” and “acute graft-versus-host disease”， relevant literatures were searched from PubMed， Web of Science， CNKI and Wanfang databases， and relevant cases were collected and analyzed. Results Hematopoietic reconstruction was successfully achieved in this 1 year 9 months old girl. On day 22 after transplantation， the skin of head and back neck of the patient showed dense red papules （approximately 19% in area）， with obvious itching. Under the treatment of oral tacrolimus and topical hormone drugs， the rash was not alleviated （area>90%）. Meanwhile， the proportion of CD3+ cells， CD8+ cells， CD3+CD69+cells and CD3+HLA-DR+cells was significantly increased， and the proportion of Treg cells was decreased. The immune indexes supported T lymphocyte activation， then diagnosis of gradeⅡaGVHD （skin grade 3） was made， and the immunosuppressive regimen was strengthened. During this period， the skin rash of the child subsided， but recurred， and accompanied by obvious skin desquamation. The proportion of CD3+ cells， CD8+ cells， and CD3+HLA-DR+cells remains relatively high， supporting the diagnosis of aGVHD. Therefore， the anti-GVHD regimen was adjusted and strengthened， and the aGVHD of the child’s skin was mitigated. Regular monitoring showed that the primary disease was completely relieved， the implantation rate was 100%， and the immune reconstitution was stable. During 32-month follow-up after transplantation， the child obtained disease-free survival. Nine relevant literatures were retrieved， all of which demonstrated that the increased proportion of early CD3+ cells， CD8+ cells， activated T lymphocytes and Treg downregulation were associated with the occurrence of aGVHD. Conclusions The dynamic monitoring of the immune status of patients after allogeneic hematopoietic stem cell transplantation is helpful to evaluate their immune reconstitution and disease status （such as， aGVHD）， thereby assisting clinicians to formulate a reasonable immunosuppressive regimen and bring favorable prognosis to patients.
Keywords
