中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (3): 215-219.

• 论著 • 上一篇    下一篇

造血干细胞移植治疗DOCK8基因突变致高IgE综合征2例病例报告

钱晓文1,4,王苹1,4,王宏胜1,江文晋1,孙金峤2,王晓川2,吴冰冰3,翟晓文1   

  1. 复旦大学附属儿科医院 上海,201102;1 血液科,2 免疫科,3 分子诊断中心,4 共同第一作者
  • 收稿日期:2019-12-16 修回日期:2020-03-16 出版日期:2020-06-25 发布日期:2020-06-25
  • 通讯作者: 翟晓文

Allogeneic hematopoietic stem cell transplantation for treatment of hyper-IgE syndrome caused by DOCK8 gene mutation in two cases:A case report

QIAN Xiao-wen1,4, WANG Ping1,4, WANG Hong-sheng1, JIANG Wen-jin1, SUN Jin-qiao2, WANG Xiao-chuan2, WU Bing-bing3, ZHAI Xiao-wen1   

  1. Children's Hospital of Fudan University, Shanghai, 201102; 1 Department of Hematology, 2 Department of Immunology, 3 Molecular Medical Center, 4 Co-First Author
  • Received:2019-12-16 Revised:2020-03-16 Online:2020-06-25 Published:2020-06-25
  • Contact: ZHAI Xiao-wen

摘要: 目的:评估异基因造血干细胞移植治疗DOCK8基因突变所致的高IgE综合征(HIES)患儿的治疗效果。方法:回顾性收集2例接受异基因造血干细胞移植治疗DOCK8基因突变所致的HIES患儿的临床特征、实验室检查、治疗和效果。结果:2例HIES患儿,例1男,移植时年龄7岁;例2女,移植时年龄9岁。例1采用同胞全相合外周血干细胞移植,例2采用非亲缘全相合脐血干细胞移植。均采用白消安联合氟达拉滨为基础的减低强度预处理方案,顺利植入并获得造血重建。中性粒细胞植入时间例1为移植后12 d,例2为移植后24 d;血小板植入时间例1为移植后13 d,例2为移植后35 d。移植后14 d嵌合检测提示为完全供者细胞嵌合。2例患儿移植期间肺部感染均有加重,经对症治疗好转。例1接受同胞供者移植,发生皮肤Ⅰ度急性移植物抗宿主反应,甲泼尼龙治疗后缓解。无其他移植相关并发症发生。2例移植后嗜酸性粒细胞及血清IgE水平均较移植前显著下降,例1和例2分别随访至移植后18和23个月,均无病生存。结论:DOCK8基因突变所致的HIES患儿可通过异基因造血干细胞移植治愈,宜采用减低强度预处理方案,同胞相合供者是最佳供者选择,非亲缘脐血干细胞移植也能取得良好疗效。

Abstract: Objective:To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of children with hyper-IgE syndrome (HIES)caused by DOCK8 gene mutation. Methods:Clinical features, laboratory data, treatment and outcome of 2 patients with HIES caused by DOCK8 gene mutation treated by allo-HSCT were retrospectively analyzed. Results:There was a boy and a girl in 2 cases with HIES. The age of allo-HSCT was 7 for the boy and 9 for the girl. The boy received matched sibling donor allo-HSCT, and the girl received matched unrelated umbilical cord blood transplantation. Reduced-intensity conditioning regimens based on Busulfan and Fludarabine were used for the 2 patients. Both patients were successfully engrafted and achieved hematopoietic reconstruction. After allo-HSCT, neutrophil engraftment occurred on day 12 and 24, and platelet engraftment occured on day 13 and 35 for the boy and girl, respectively. Both patients showed stable complete donor chimerism 14 days after allo-HSCT. Pulmonary infection in both patients aggravated during transplantation, and conditions were improved with active therapy. The boy who received matched sibling donor allo-HSCT suffered grade Ⅰ acute skin graft-versus-host disease (GVHD), and his condition was alleviated after the methylprednisone treatment. No other complications were reported. The levels of eosinophils and serum IgE were much lower than those before transplantation. Two children survived disease-free for 18 months and 23 months after transplantation. Conclusion:Children with HIES caused by DOCK8 gene mutation can be cured by allo-HSCT. It is advisable to adopt a reduced-intensity conditioning regimen. Matched sibling donors are the best choice for allo-HSCT, and unrelated umbilical cord blood stem cell transplantation can also achieve good results.