Combined mesenchymal stem cells and telitacicept therapy for Evans syndrome refractory to various immunosuppressive: a case report.

BACKGROUND

Evans syndrome (ES) is a rare autoimmune cytopenia characterized by autoimmune hemolytic anemia and immune thrombocytopenia. Patients who are refractory to multiple immunosuppressive therapies have limited treatment options, and long-term outcomes remain poor.

KEY CLINICAL QUESTION: Can combined immunomodulatory therapy with telitacicept and mesenchymal stem cells (MSCs) achieve effective disease control in patients with refractory ES who have failed conventional and advanced therapies?

CLINICAL APPROACH: A 41-year-old woman with refractory ES, unresponsive to multiple therapies including corticosteroids, intravenous immunoglobulin, rituximab, thrombopoietin receptor agonists, daratumumab, and splenectomy, was treated with combined telitacicept (160 mg weekly) and MSCs (2 × 106 cells/kg weekly). Hemoglobin improved within 2 weeks, platelet recovery began by week 4, and sustained remission was maintained at 1-year follow-up without infectious complications.

CONCLUSION

This case suggests that combined therapy with telitacicept and MSCs may represent an effective therapeutic option for patients with refractory ES. The complementary immunosuppressive mechanisms of BAFF/APRIL blockade and MSC-mediated immune regulation may provide synergistic disease control and warrant further investigation in larger clinical studies.