中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (33): 5269-5274.doi: 10.3969/j.issn.2095-4344.1835

• 干细胞移植 stem cell transplantation • 上一篇    下一篇

造血干细胞移植治疗重型再生障碍性贫血：血小板生成素促血小板植入的有效性和安全性

郭  智1，任  骅1，吉  勇1，陈丽萍1，陈丽娜1，刘玄勇1，郑珊珊1，刘晓东2，陈惠仁2   

  1. 1国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院血液科，广东省深圳市  518116；2中国人民解放军总医院第七医学中心血液科，北京市  100700
  • 修回日期:2019-05-24 出版日期:2019-11-28 发布日期:2019-11-28
  • 通讯作者: 陈惠仁，主任医师，教授，博士生导师，中国人民解放军总医院第七医学中心血液科，北京市 100700
  • 作者简介:郭智，男，1977年生，湖北省武汉市人，汉族，2000年同济医科大学毕业，硕士，主任医师，教授，硕士生导师，主要从事血液肿瘤诊治和造血干细胞移植工作。
  • 基金资助:

    深圳市卫生系统科研项目(SZLY2018003)，项目负责人：郭智；中国医学科学院肿瘤医院深圳医院2018年医疗卫生三名工程课题(2018-nk003)，项目负责人：郭智

Thrombopoietin improves platelet recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia: an assessment of safety and efficacy 

Guo Zhi1, Ren Hua1, Ji Yong1, Chen Liping1, Chen Lina1, Liu Xuanyong1, Zheng Shanshan1, Liu Xiaodong2, Chen Huiren2   

  1. 1Department of Hematology, National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China; 2Department of Hematology, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
  • Revised:2019-05-24 Online:2019-11-28 Published:2019-11-28
  • Contact: Chen Huiren, Chief physician, Professor, Doctoral supervisor, Department of Hematology, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
  • About author:Guo Zhi, Master, Chief physician, Professor, Master’s supervisor, Department of Hematology, National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
  • Supported by:

    Shenzhen Health System Research Project, No. SZLY2018003 (to GZ); 2018 Medical and Health Engineering Project of Cancer Hospital, Chinese Academy of Medical Sciences, Shenzhen Center, No. 2018-nk003 (to GZ)

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摘要：

文章快速阅读：

文题释义：
血小板生成素：又称巨核细胞生长衍生因子，能特异性刺激巨核系祖细胞增殖分化，促进巨核细胞成熟，还能强烈促进核细胞或巨噬细胞和红系祖细胞的恢复，有诱导造血祖细胞动员进入外周循环的作用，血小板生成素主要产生于肝和肾脏，血清游离血小板生成素浓度是通过黏附因子表达在人外周血血小板和巨核细胞上的c-mpl基因来调节，在血小板疾病中应用意义重大。
造血干细胞移植：已在临床广泛应用于良恶性血液系统疾病的治疗，是通过大剂量放、化疗彻底破坏患者的造血及免疫系统，然后输入供者或者患者正常的造血干细胞，重建患者造血功能和免疫功能，从而达到治疗目的。

 

摘要
背景：研究表明，异基因造血干细胞移植后应用血小板生成素在造血调控、造血重建等方面有一定作用，为临床推广应用提供理论基础。
目的：分析血小板生成素在异基因造血干细胞移植治疗重型再生障碍性贫血中促进血小板植入的临床疗效和安全性。
方法：2012年1月至2017年1月共入选50例接受异基因造血干细胞移植治疗的重型再生障碍性贫血患者，分为治疗组和对照组各25例，其中男28例，女22例，平均年龄27.8(16-48)岁，治疗组在移植后7 d起应用血小板生成素300 U/kg，连续14 d，比较两组患者血小板植入后在≥20×109 L-1、50×109 L-1和100×109 L-1的时间节点及血小板中位输注次数。该治疗方案得到解放军陆军总医院伦理委员会批准和患者知情同意。
结果与结论：两组患者均获造血重建，治疗组和对照组血小板≥20×109 L-1、50×109 L-1和100×109 L-1的中位时间分别为16.2，19.3，30.2 d和18.8，25.8，38.5 d，治疗组血小板植入时间比对照组分别提前2.6，6.5，8.3 d，辐照血小板中位输注次数分别为6.8次和9.5次，两组数据结果显示差异有显著性意义(P < 0.05)。随访至2017年7月，两组患者无病生存率分别为80%，72%。结果表明，血小板生成素能够促进异基因造血干细胞移植后血小板植入及恢复，且患者耐受性好，值得临床进一步推广应用。


中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程
ORCID: 0000-0002-1164-9978(郭智)

关键词: 重型再生障碍性贫血, 异基因造血干细胞移植, 血小板生成素, 血小板植入, 造血调控, 造血重建

Abstract:

BACKGROUND: Studies have shown that the use of thrombopoietin after allogeneic hematopoietic stem cell transplantation has a certain role in hematopoietic regulation and hematopoietic reconstitution, providing a theoretical basis for clinical application.
OBJECTIVE: To analyze the clinical efficacy and safety of thrombopietin in the treatment of severe aplastic anemia after hematopoietic stem cell transplantation.
METHODS: Fifty patients receiving allogeneic hematopoietic stem cell transplantation from January 2012 to January 2017 including 28 males and 22 females with the mean age of 27.8 (16-48) years were enrolled. Patients received 300 U/kg thrombopietin (treatment group, n=25) subcutaneously, which began at 7 days after transplantation, or were only treated with symptomatic treatment (control group, n=25). Time node of platelet implantation in two groups of patients ≥ 20×109/L, 50×109/L, and 100×109/L and median Infusion times of platelet were compared between two groups. The study protocol was approved by the Ethics Committee of Army General Hospital, and enrolled patients signed informed consent prior to the inception of the trial.
RESULTS AND CONCLUSION: The median time of platelet implantation ≥ 20×109/L, 50×109/L, and 100×109/L was 16.2, 19.3, and 30.2 days in the treatment group and 18.8, 25.8, and 38.5 days in the control group, respectively. The time of platelet implantation time in the treatment group was 2.6, 6.5, and 8.3 days earlier than that in the control group. The median number of irradiated platelet implantation was 6.8 times in the treatment group and 9.5 times in the control group. There was a significant difference between the two groups (P < 0.05). All the patients were followed up to July 2017, and the disease-free survival rates were 80% in the treatment group and 72% in the control group. These findings indicate that thrombopietin can promote platelet implantation and recovery after allogeneic hematopoietic stem cell transplantation, and is well tolerated, which is worthy of further clinical application.

Key words: severe aplastic anemia, allogeneic hematopoietic stem cell transplantation, thrombopoietin, platelet implantation, hematopoietic regulation, hematopoietic reconstitution

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