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Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2018; 17: 23-28

Аутоиммунные заболевания у детей с приобретенной апластической анемией

Горонкова О.В. , Калинина И.И. , Салимова Т.Ю. , Сунцова Е.В. , Петрова У.Н. , Байдильдина Д.Д. , Масчан М.А. , Новичкова Г.А. , Масчан А.А.

https://doi.org/10.24287/1726-1708-2018-17-1-23-28

Аннотация

Сочетание апластической анемии (АА) с другими аутоиммунными заболеваниями (АЗ) встречается редко и до конца не изучено. Проведен анализ литературы, представлены собственные данные о частоте встречаемости и исходах АЗ в сочетании с АА и результаты лечения сопутствующих АЗ в ретроспективном одноцентровом исследовании 370 пациентов с АА, которые находились в РДКБ и НМИЦ детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева Минздрава России в 1996-2014 годах и получали иммуносупрессивную терапию (ИСТ) (296) или трансплантацию гемопоэтических стволовых клеток (ТГСК) (74) с медианой периода наблюдения 7 лет (0,5-18 лет). Клинические проявления АЗ наблюдались у 10 из 370 (2,7%) пациентов. Возраст на момент диагностики АА был сходным у пациентов с АЗ и без него (медиана - 10,9 и 10 лет соответственно; р 0,05). У 3 пациентов, которым диагноз АЗ был установлен до начала лечения АА, ответ на антитимоцитарный глобулин был достигнут со стороны AA (у 2 из 3 пациентов), но не достигнут со стороны АЗ (0 из 3). У 7 пациентов с дебютом АЗ после терапии первой линии по поводу АА медиана времени до развития АЗ составила 6 мес. (2 мес.-13,4 года). Ответ АА на антитимоцитарный глобулин был достигнут у всех пациентов (7 из 7), однако лечение АЗ оказалось успешным лишь у 43% (3 из 7). Сочетание АА и АЗ у детей наблюдается очень редко. В большинстве случаев ИСТ была эффективна в отношении АА, однако не влияла на исход сопутствующего АЗ.
Список литературы

1. Zeng W., Nakao S., Takamatsu H., Yachie A., Takami A., Kondo Y., Sugimori N., et al. Characterization of T-cell repertoire of the bone marrow in immune-mediated aplastic anemia: evidence for the involvement of antigen-driven T-cell response in cyclosporine-dependent aplastic anemia. Blood 1999 May 1; 93 (9): 3008-16.

2. Melenhorst J.J., van Krieken J.H., Dreef E., Landegent J.E., Willemze R., Fibbe W.E. T-cells selectively infiltrate bone marrow areas with residual haemopoiesis of patients with acquired aplastic anaemia. Br J Haematol 1997; 99 (3): 517-9.

3. Bacigalupo A., Bruno B., Saracco P., Di Bona E., Locasciulli A., Locatelli F., Gabbas A., et al. Antilymphocyte globulin, cyclosporine, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia: an update of the GITMO/EBMT study on 100 patients. European Group for Blood and Marrow Transplantation (EBMT) Working Party on Severe Aplastic Anemia and the Gruppo Italiano Trapianti di Midolio Osseo (GITMO). Blood 2000 Mar 15; 95 (6):1931-4.

4. Tichelli A., Schrezenmeier H., Socié G., Marsh J., Bacigalupo A., Dührsen U., Franzke A., et al. A randomized controlled study in patients with newly diagnosed severe aplastic anemia receiving antithymocyte globulin (ATG), cyclosporine, with or without G-CSF: a study of the SAA Working Party of the European Group for Blood and Marrow Transplantation. Blood 2011 Apr 28; 117 (17): 4434-41.

5. Ahmad S.Q., Khan O., Zafar S.I., Zafar S.N. A case of systemic lupus erythematosus with aplastic anaemia. The Journal of the Pakistan Medical Association 2011; 61 (8): 817-9.

6. de Oliveira L.R., Ferreira T.C., Neves Fde F., Meneses A.C. Aplastic anemia associated to systemic lupus erythematosus in an AIDS patient: a case report. Rev Bras Hematol Hemoter 2013; 35 (5): 366-8.

7. Badyal R.K., Sachdeva M.U., Varma N., Thapa B.R. A rare association of celiac disease and aplastic anemia: case report of a child and review of literature. Pediatr Dev Pathol 2014; 17 (6): 470-3.

8. Maheshwari A., Nirupam N., Aneja S., Meena R., Chandra J., Kumar P. Association of celiac disease with aplastic anemia. Indian J Pediatr 2012; 79(10): 1372-3.

9. Grey-Davies E., Hows J.M., Marsh J.C. Aplastic anaemia in association with coeliac disease: a series of three cases. Br J Haematol 2008; 143 (2): 258-60.

10. Cesaro S., Marsh J., Tridello G., Rovò A, Maury S., Montante B. et al. Retrospective survey on the prevalence and outcome of prior autoimmune diseases in patients with aplastic anemia reported to the registry of the European group for blood and marrow transplantation. Acta Haematol 2010; 124 (1): 19-22.

11. Stalder M.P., Rovo A., Halter J., Heim D., Silzle T., et al. Aplastic anemia and concomitant autoimmune diseases. Annals of hematology 2009; 88 (7): 659-65.

12. Strickland R.G., Mackay I.R. A reappraisal of the nature and significance of chronic atrophic gastritis. Am J Dig Dis 1973; 18: 426-40.

13. Albers J.W., Kelly J.J. Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features. Muscle Nerve 1989; 12: 435-51.

14. Boin F., Hummers L.K. Scleroderma-like fibrosing disorders. Rheum Dis Clin North Am 2008; 34: 199-220.

15. Dayan C.M., Daniels G.H. Chronic autoimmune thyroiditis. N Engl J Med 1996; 335: 99-107.

16. Hochberg M.C. Classification criteria for childhood arthritic diseases. J Rheumatol 1995; 22: 1445-6.

17. McMillan R. The pathogenesis of chronic immune thrombocytopenic purpura. Semin Hematol 2007; 44: S3-S11.

18. Nikolaus S., Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology 2007; 133: 1670-89.

19. Camitta B.M., Thomas E.D., Nathan D.G., Santos G., et al. Severe aplastic anemia: a prospective study of the effect of early marrow transplantation on acute mortality. Blood 1976; 48: 63-70.

20. Eaton W.W., Rose N.R., Kalaydjian A., Pedersen M.G., Mortensen P.B. Epidemiology of autoimmune diseases in Denmark. J Autoimmun 2007; 29: 1-9

21. Young N.S. Pathophysiologic mechanisms in acquired aplastic anemia. Hematology Am Soc Hematol Educ Program 2006; 1: 72-7.

22. Risitano A.M. Immunosuppressive therapies in the management of immune-mediated marrow failures in adults: where we stand and where we are going. British Journal of haematology 2011 Jan; 152 (2): 127-40.

23. Lu J., Basu A., Melenhorst J.J., Young N.S., Brown K.E. Analysis of T-cell repertoire in hepatitis-associated aplastic anemia. Blood 2004; 103: 4588-93.

24. Brown K.E., Tisdale J., Barrett A.J., Dunbar C.E., Young N.S. Hepatitis-associated aplastic anemia. N Engl J Med 1997; 336: 1059-64.

25. Goto M., Kuribayashi K., Takahashi Y., Kondoh T., Tanaka M., Kobayashi D., Watanabe N., et al. Identification of autoantibodies expressed in acquired aplastic anaemia. Br J Haematol 2013; 160 (3): 359-62.

26. Trendelenburg M., Gregor M., Passweg J., Tichelli A. Altered immunity syndrome, a distinct entity in long-term bone marrow transplantation survivors. Bone Marrow Transplant 2001; 28: 1175-6.

Pediatric Hematology/Oncology and Immunopathology. 2018; 17: 23-28

Autoimmune diseases in children with acquired aplastic anemia

Goronkova O. V., Kalinina I. I., Salimova T. Yu., Suntsova E. V., Petrova U. N., Baydildina D. D., Мaschan M. A., Novichkova G. A., Мaschan A. A.

https://doi.org/10.24287/1726-1708-2018-17-1-23-28

Abstract

The association of aplastic anemia (AA) with other autoimmune diseases (AID) is rarely described and so far not systematically evaluated. We have analysed the literature data and present our own experience. We assessed the incidence and the outcome of concomitant AID in a retrospective, single-center study of 370 patients with AA treated between 1996 and 2014 with either immunosuppression (296) or hematopoietic stem cell transplantation (74) and a median follow-up time of 7 years (0.5–18). Results: Clinically manifest AID were observed in 10 out of 370 (2.7%) patients. Age at diagnosis of AA was similar in patients without AID compared to patients with AID (median, 10,9 versus 10 years; p > 0.05). In 3 patients where the diagnosis of AID was done before AA therapy, response to antithymocyte globulin was good for AA (2 out of 3) but not for AID (0 out of 3). In 7 patients in which AID occurred after first-line therapy, the median time to the AID was 6 months (range 2 months–13.4 years). Response to antithymocyte globulin was good for AA (7 out of 7), but treatment of AID was successful in 43% (3 out of 7) patients. Conclusions: The association of AA with AID in children is very rare. Most cases of AA in association with AID benefitted from IST, but IST was not influence to outcome of concomitant AID.

References

1. Zeng W., Nakao S., Takamatsu H., Yachie A., Takami A., Kondo Y., Sugimori N., et al. Characterization of T-cell repertoire of the bone marrow in immune-mediated aplastic anemia: evidence for the involvement of antigen-driven T-cell response in cyclosporine-dependent aplastic anemia. Blood 1999 May 1; 93 (9): 3008-16.

2. Melenhorst J.J., van Krieken J.H., Dreef E., Landegent J.E., Willemze R., Fibbe W.E. T-cells selectively infiltrate bone marrow areas with residual haemopoiesis of patients with acquired aplastic anaemia. Br J Haematol 1997; 99 (3): 517-9.

3. Bacigalupo A., Bruno B., Saracco P., Di Bona E., Locasciulli A., Locatelli F., Gabbas A., et al. Antilymphocyte globulin, cyclosporine, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia: an update of the GITMO/EBMT study on 100 patients. European Group for Blood and Marrow Transplantation (EBMT) Working Party on Severe Aplastic Anemia and the Gruppo Italiano Trapianti di Midolio Osseo (GITMO). Blood 2000 Mar 15; 95 (6):1931-4.

4. Tichelli A., Schrezenmeier H., Socié G., Marsh J., Bacigalupo A., Dührsen U., Franzke A., et al. A randomized controlled study in patients with newly diagnosed severe aplastic anemia receiving antithymocyte globulin (ATG), cyclosporine, with or without G-CSF: a study of the SAA Working Party of the European Group for Blood and Marrow Transplantation. Blood 2011 Apr 28; 117 (17): 4434-41.

5. Ahmad S.Q., Khan O., Zafar S.I., Zafar S.N. A case of systemic lupus erythematosus with aplastic anaemia. The Journal of the Pakistan Medical Association 2011; 61 (8): 817-9.

6. de Oliveira L.R., Ferreira T.C., Neves Fde F., Meneses A.C. Aplastic anemia associated to systemic lupus erythematosus in an AIDS patient: a case report. Rev Bras Hematol Hemoter 2013; 35 (5): 366-8.

7. Badyal R.K., Sachdeva M.U., Varma N., Thapa B.R. A rare association of celiac disease and aplastic anemia: case report of a child and review of literature. Pediatr Dev Pathol 2014; 17 (6): 470-3.

8. Maheshwari A., Nirupam N., Aneja S., Meena R., Chandra J., Kumar P. Association of celiac disease with aplastic anemia. Indian J Pediatr 2012; 79(10): 1372-3.

9. Grey-Davies E., Hows J.M., Marsh J.C. Aplastic anaemia in association with coeliac disease: a series of three cases. Br J Haematol 2008; 143 (2): 258-60.

10. Cesaro S., Marsh J., Tridello G., Rovò A, Maury S., Montante B. et al. Retrospective survey on the prevalence and outcome of prior autoimmune diseases in patients with aplastic anemia reported to the registry of the European group for blood and marrow transplantation. Acta Haematol 2010; 124 (1): 19-22.

11. Stalder M.P., Rovo A., Halter J., Heim D., Silzle T., et al. Aplastic anemia and concomitant autoimmune diseases. Annals of hematology 2009; 88 (7): 659-65.

12. Strickland R.G., Mackay I.R. A reappraisal of the nature and significance of chronic atrophic gastritis. Am J Dig Dis 1973; 18: 426-40.

13. Albers J.W., Kelly J.J. Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features. Muscle Nerve 1989; 12: 435-51.

14. Boin F., Hummers L.K. Scleroderma-like fibrosing disorders. Rheum Dis Clin North Am 2008; 34: 199-220.

15. Dayan C.M., Daniels G.H. Chronic autoimmune thyroiditis. N Engl J Med 1996; 335: 99-107.

16. Hochberg M.C. Classification criteria for childhood arthritic diseases. J Rheumatol 1995; 22: 1445-6.

17. McMillan R. The pathogenesis of chronic immune thrombocytopenic purpura. Semin Hematol 2007; 44: S3-S11.

18. Nikolaus S., Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology 2007; 133: 1670-89.

19. Camitta B.M., Thomas E.D., Nathan D.G., Santos G., et al. Severe aplastic anemia: a prospective study of the effect of early marrow transplantation on acute mortality. Blood 1976; 48: 63-70.

20. Eaton W.W., Rose N.R., Kalaydjian A., Pedersen M.G., Mortensen P.B. Epidemiology of autoimmune diseases in Denmark. J Autoimmun 2007; 29: 1-9

21. Young N.S. Pathophysiologic mechanisms in acquired aplastic anemia. Hematology Am Soc Hematol Educ Program 2006; 1: 72-7.

22. Risitano A.M. Immunosuppressive therapies in the management of immune-mediated marrow failures in adults: where we stand and where we are going. British Journal of haematology 2011 Jan; 152 (2): 127-40.

23. Lu J., Basu A., Melenhorst J.J., Young N.S., Brown K.E. Analysis of T-cell repertoire in hepatitis-associated aplastic anemia. Blood 2004; 103: 4588-93.

24. Brown K.E., Tisdale J., Barrett A.J., Dunbar C.E., Young N.S. Hepatitis-associated aplastic anemia. N Engl J Med 1997; 336: 1059-64.

25. Goto M., Kuribayashi K., Takahashi Y., Kondoh T., Tanaka M., Kobayashi D., Watanabe N., et al. Identification of autoantibodies expressed in acquired aplastic anaemia. Br J Haematol 2013; 160 (3): 359-62.

26. Trendelenburg M., Gregor M., Passweg J., Tichelli A. Altered immunity syndrome, a distinct entity in long-term bone marrow transplantation survivors. Bone Marrow Transplant 2001; 28: 1175-6.