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Acquired aplastic anemia:Is bystander insult to autologous hematopoiesis driven by immune surveillance against malignant cells?

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World Journal of Stem Cells 2020年第11期12卷 1429-1438页

作者： Xi-Chen Zhao Xiao-Yun Sun Bo Ju Fan-Jun Meng Hong-Guo Zhao Department of Hematology The Central Hospital of Qingdao West Coast New AreaQingdao 266555Shandong ProvinceChina Department of Hematology The Affiliated Hospital of Qingdao UniversityQingdao 266000Shandong ProvinceChina

We previously reported a serendipitous finding from a patient with refractory severe aplastic anemia who had gotten an unexpected hematological response to treatment with gut-cleansing preparations(GCPs).This patient experienced three recurrences over the ensuing one year of intermittent GCP treatments,with each recurrence occurring 7-8 wk from a *** his third recurrence,he was prescribed successive treatment with rifampicin,berberine,and monthly administered GCP for 4 mo,and he developed an erythroid proliferative neoplasma and an overwhelming enteropathy,and eventually died of septic *** investigations had validated the resolution of myelosuppression and the appearance of malignant clonal *** the treatment process and laboratory investigations,it is reasonably inferred that the engagement of gut inflammation is critically required in sustaining the overall pathophysiology of acquired aplastic anemia probably by creating a chronic inflammatory *** of rifampicin,berberine,and monthly GCP into cyclosporine can enhance the immunosuppressive *** a subgroup of acquired aplastic anemia patients whose pathogenesis is associated with genotoxic exposure,the suppressed normal hematopoiesis may result from the bystander insult that is mediated by the soluble inflammatory cytokines generated in response to the immunogenic products of damaged hematopoietic cells in the context of chronic inflammatory state and may offer a protective antineoplastic mechanism against malignant proliferation.

关键词： Acquired aplastic anemia bystander insult Malignant clonal hematopoiesis Immune surveillance Antineoplastic Gut inflammation

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