顿挫型 WAS
现在认为长期前景良好。长期并发症包括严重出血和发生自身免疫性疾病的风险。[4]Imai K, Morio T, Zhu Y, et al. Clinical course of patients with WASP gene mutations. Blood. 2004;103:456-464.http://bloodjournal.hematologylibrary.org/content/103/2/456.longhttp://www.ncbi.nlm.nih.gov/pubmed/12969986?tool=bestpractice.com
重症WAS
近年来由于使用预防疗法,故没有进行骨髓移植的患者的长期前景也有所改善。 有限的资料表明患者很难存活30年。[4]Imai K, Morio T, Zhu Y, et al. Clinical course of patients with WASP gene mutations. Blood. 2004;103:456-464.http://bloodjournal.hematologylibrary.org/content/103/2/456.longhttp://www.ncbi.nlm.nih.gov/pubmed/12969986?tool=bestpractice.com 严重出血(尤其是颅内出血)、严重感染和自身免疫性疾病是发病和死亡的主要原因。[1]O'Sullivan E, Kinnon C, Brickell P. Wiskott-Aldrich syndrome protein, WASP. Int J Biochem Cell Biol. 1999;31:383-387.http://www.ncbi.nlm.nih.gov/pubmed/10224664?tool=bestpractice.com[4]Imai K, Morio T, Zhu Y, et al. Clinical course of patients with WASP gene mutations. Blood. 2004;103:456-464.http://bloodjournal.hematologylibrary.org/content/103/2/456.longhttp://www.ncbi.nlm.nih.gov/pubmed/12969986?tool=bestpractice.com[7]Litzman J, Jones A, Hann I, et al. Intravenous immunoglobulin, splenectomy, and antibiotic prophylaxis in Wiskott-Aldrich syndrome. Arch Dis Child. 1996;75:436-439.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511781/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/8957959?tool=bestpractice.com[21]Dupuis-Girod S, Medioni J, Haddad E, et al. Autoimmunity in Wiskott-Aldrich syndrome: risk factors, clinical features, and outcome in a single-center cohort of 55 patients. Pediatrics. 2003;111:e622-e627.http://pediatrics.aappublications.org/content/111/5/e622.longhttp://www.ncbi.nlm.nih.gov/pubmed/12728121?tool=bestpractice.com 此外,10%至20%的患者可发生血液系统恶性肿瘤(淋巴瘤和 骨髓增生异常综合征)并发症。[4]Imai K, Morio T, Zhu Y, et al. Clinical course of patients with WASP gene mutations. Blood. 2004;103:456-464.http://bloodjournal.hematologylibrary.org/content/103/2/456.longhttp://www.ncbi.nlm.nih.gov/pubmed/12969986?tool=bestpractice.com[7]Litzman J, Jones A, Hann I, et al. Intravenous immunoglobulin, splenectomy, and antibiotic prophylaxis in Wiskott-Aldrich syndrome. Arch Dis Child. 1996;75:436-439.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511781/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/8957959?tool=bestpractice.com
骨髓移植可以治愈。 不论是匹配的同胞供体或完全匹配的无血缘关系供体,五年生存率已经在过去十年显著改进,现在接近90%。 一般避免使用不匹配家庭成员供体移植,这是由于其存活率(50%至55%)较低,尽管在这一组存活率也在提高。[22]Filipovich AH, Stone JV, Tomany SC, et al. Impact of donor type on outcome of bone marrow transplantation for Wiskott-Aldrich syndrome: collaborative study of the International Bone Marrow Transplant Registry and the National Marrow Donor Program. Blood. 2001;97:1598-1603.http://bloodjournal.hematologylibrary.org/content/97/6/1598.longhttp://www.ncbi.nlm.nih.gov/pubmed/11238097?tool=bestpractice.com[23]Ozsahin H, Cavazzana-Calvo M, Notarangelo LD, et al. Long-term outcome following hematopoietic stem-cell transplantation in Wiskott-Aldrich syndrome: collaborative study of the European Society for Immunodeficiencies and European Group for Blood and Marrow Transplantation. Blood. 2008;111:439-445.http://bloodjournal.hematologylibrary.org/content/111/1/439.longhttp://www.ncbi.nlm.nih.gov/pubmed/17901250?tool=bestpractice.com[24]Moratto D, Giliani S, Bonfim C, et al. Long-term outcome and lineage-specific chimerism in 194 Wiskott-Aldrich syndrome patients treated by hematopoietic cell transplantation between 1980-2009: an international collaborative study. Blood. 2011;118:1675-1684.http://bloodjournal.hematologylibrary.org/content/118/6/1675.longhttp://www.ncbi.nlm.nih.gov/pubmed/21659547?tool=bestpractice.com[25]Elfeky RA, Furtado-Silva JM, Chiesa R, et al. One hundred percent survival after transplantation of 34 patients with Wiskott-Aldrich syndrome over 20 years. J Allergy Clin Immunol. 2018 Jul 25. pii: S0091-6749(18)31059-5.http://www.ncbi.nlm.nih.gov/pubmed/30055182?tool=bestpractice.com