自体造血干细胞移植中不同预处理方案与血小板输注的临床分析*

doi:10.3969/j.issn.1671-2587.2021.06.002

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (6): 686-692.DOI: 10.3969/j.issn.1671-2587.2021.06.002

• 组织器官移植输血专题（二） • 上一篇下一篇

自体造血干细胞移植中不同预处理方案与血小板输注的临床分析^*

王倩, 杨李辉, 丁天凌, 夏荣

200040 上海,复旦大学附属华山医院血液科（王倩,丁天凌）; 复旦大学附属华山医院输血科（杨李辉,夏荣）

收稿日期:2021-08-17 出版日期:2021-12-20 发布日期:2021-12-21
通讯作者: 丁天凌,男,副主任医师,博士,主要从事造血干细胞移植的研究,（E-mail）dtl_953105@163.com。共同通信作者：夏荣,男,主任医师,博士,主要从事输血相关免疫调节的研究,（E-mail）xiarongcn@126.com。
作者简介:王倩（1981-）,女,山东诸城人,副主任医师,博士,主要从事血液肿瘤诊治的研究,（E-mail）wangqian2004_2@126.com。并列第一作者：杨李辉（1969-）,女,上海金山人,主管技师,学士,主要从事临床输血的研究,（E-mail）13801692129@139.com。
基金资助:
*本课题受国家自然科学基金青年项目（No.81100389）,国家自然科学基金面上项目（No.82070197）,2020年度复旦大学附属华山医院原创科研个性化支持项目（No.IDF151039/058）资助

Clinical Analysis of Platelet Transfusion for Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation with Different Conditioning Regimens

WANG Qian, YANG Li-hui, DING Tian-ling, et al

Department of Hematology,Huashan Hospital, Fudan University, Shanghai 200040

Received:2021-08-17 Online:2021-12-20 Published:2021-12-21

摘要/Abstract

摘要： 目的总结自体造血干细胞移植患者移植期间血小板输注的阈值、需求量、输注效率和植入动力学,以及不同预处理方案对血小板输注的影响。方法本研究为单中心回顾性临床研究,纳入复旦大学附属华山医院血液科2013年11月~2021年3月进行自体造血干细胞移植且在移植期间输注单采血小板的94例患者,根据不同的预处理方案分析比较了患者回输的总有核细胞计数、CD34⁺单个核细胞计数、血小板输注阈值、输注量、输注效率及血小板植入动力学。结果纳入的94例患者回输的总有核细胞计数均值为（3.02±1.28）×10⁸/kg、CD34⁺单个核细胞均值为（4.76±2.25）×10⁶/kg,人均血小板输注量为2.16个治疗剂量,总体输注有效率为74.38%,血小板植入的中位时间为12天;血小板计数≤10×10⁹/L的患者血小板输注量、有效输注率、植入时间和输注效果与血小板计数>10×10⁹/L的患者无显著差异;接受马法兰单药、BuCy方案、CEC方案预处理的患者,在血型分布、回输总有核细胞计数、CD34⁺单个核细胞计数和基线血小板无差异的情况下,BuCy组患者血小板输注量多于马法兰单药组和CEC方案组（P<0.05）,BuCy组患者血小板下降至输注阈值的速度较马法兰单药组和CEC方案组更快（P<0.05）,且植入时间更长（P<0.05）。结论自体造血干细胞移植过程中,在积极控制临床并发症和避免使用影响血小板的药物基础上,选择10×10⁹/L作为血小板预防性输注阈值可降低发生严重出血事件的风险。相比马法兰单药和CEC方案,BuCy方案对患者血小板的下降速度和植入时间影响更大,患者对血小板需求量多,但输注效率未受影响,无需过度提高血小板输注阈值。

关键词: 血小板输注, 自体造血干细胞移植, 预防性输注, 预处理方案

Abstract: Objective To evaluate the platelet transfusion threshold, demand, transfusion efficiency and engraftment kinetics of inpatients undergoing autologous hematopoietic stem cell transplantation（ASCT）, as well as the influence of different conditioning regimens on platelet transfusion. Methods This study was a single-center retrospective clinical study,and enrolled 94 patients who underwent ASCT and received platelet transfusions from November 2013 to March 2021 in the Department of Hematology,HuaShan Hospital affiliated to FuDan University. The influence of different conditioning regimens was compared on nucleated cell count,CD34⁺ stem cell dose,platelet transfusion threshold,total platelet transfusion dosage,transfusion efficiency and platelet engraftment kinetics. Results The mean value of nucleated cell and CD34⁺ stem cell reinfusion was（3.02±1.28）×10⁸/kg and（4.76±2.25）×10⁶/kg respectively,the average platelet transfusion per capita was 2.16 dose,the overall transfusion efficiency was 74.38%,and the median time of platelet engraftment was 12 days. Platelet transfusion dosage,effective transfusion rate,engraftment time and transfusion effect were similar between the groups of patients with platelet count below or over 10×10⁹/L. Patients was subgrouped into three groups with melphalan monotherapy,BuCy regimen,and CEC regimen,and there was no difference in blood type distribution,nucleated cell count,CD34⁺ stem cell dose and baseline platelets count among three groups. The data showed the amount of platelet transfusion in BuCy group was more than that of melphalan monotherapy group and CEC group（P<0.05）,the rate of platelet reduction in BuCy group was faster than that in melphalan monotherapy group and CEC group（P<0.05）, as well as the engraftment time was longer in BuCy group （P<0.05）. Conclusion In ASCT, on the basis of effective controlling complications and avoiding drug-related thrombocytopenia, the prophylactic platelet transfusion threshold can be triggered with 10×10⁹/L to reduce the risk of serious bleeding events. Compared with melphalan monotherapy and CEC regimen,BuCy regimen has a greater impact on the platelet reduction and engraftment time and patients require more platelet transfusions. However,due to the similar transfusion efficiency,there is no need to increase the platelet transfusion threshold.

Key words: Platelet transfusion, Autologous hematopoietic stem cell transplantation, Prophylactic transfusion conditioning regimen

中图分类号:

R457

王倩, 杨李辉, 丁天凌, 夏荣. 自体造血干细胞移植中不同预处理方案与血小板输注的临床分析^*[J]. 临床输血与检验, 2021, 23(6): 686-692.

WANG Qian, YANG Li-hui, DING Tian-ling, et al. Clinical Analysis of Platelet Transfusion for Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation with Different Conditioning Regimens[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(6): 686-692.

参考文献

[1] COPELAN E A.Hematopoietic stem-cell transplantation[J]. N Engl J Med,2006,354(17):1813-1826.
[2] ZAHID U, AKBAR F, AMARANENI A, et al.A Review of Autologous Stem Cell Transplantation in Lymphoma[J].Curr Hematol Malig Rep,2017,12(3):217-226.
[3] SONG G Y, JUNG S H, LEE J J, et al.Intravenous busulfan and melphalan versus high-dose melphalan as a conditioning regimen for early autologous stem cell transplantation in patients with multiple myeloma: a propensity score-matched analysis[J]. Leuk Lymphoma,2020,61(11):2714-2721.
[4] CHEN Y B, LANE A A, LOGAN B, et al.Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation[J]. Biol Blood Marrow Transplant,2015,21(6):1046-1053.
[5] 杨懿春, 岑雪波, 罗小华, 等. CEAC预处理后行自体造血干细胞移植对非霍奇金淋巴瘤患者的疗效评价[J]. 第三军医大学学报, 2019,41(23): 2272-2279.
[6] 滕清良, 张春梅, 马华, 等. 环磷酰胺、依托泊苷、卡铂预处理方案在实体瘤中的应用[J]. 山东医药,2008,48(22):64-65.
[7] YUAN S, YANG D, NAKAMURA R, et al.Red blood cell and platelet transfusion support in the first 30 and 100 days after allogeneic hematopoietic cell transplant[J]. Transfusion,2020,60(10):2225-2242.
[8] GANGULY S, BRADLEY J P, PATEL J S, et al.Role of transfusion in stem cell transplantation: a freedom-from-transfusion (FFT), cost and survival analysis[J]. J Med Econ,2010,13(1):55-62.
[9] AUBRON C, ARIES P, LE NIGER C, et al.How clinicians can minimize transfusion-related adverse events?[J]. Transfus Clin Biol,2018,25(4):257-261.
[10] YAMANAKA M, YANAGISAWA R, KOJIMA S, et al.Investigation of factors associated with allergic transfusion reaction due to platelet transfusion and the efficacy of platelets resuspended in BRS-A in adult patients[J]. Transfusion,2019,59(11):3405-3412.
[11] CHENNA D, SHASTRY S, BALIGA P.Evaluation and monitoring of response to platelet transfusion therapy: experience from a tertiary care center[J]. Acta Clin Belg,2021,76(4):300-303.
[12] PYTLÍK R, VACKOVÁ B, KONÍOVÁ E, et al. Long-term outcomes of older patients with relapsed/refractory NHL referred to ASCT[J]. Bone Marrow Transplant,2021,56(3):709-712.
[13] ANSEN L, MERZ M, ENGELHARDT M, et al.Autologous stem cell transplantation in multiple myeloma patients: utilization patterns and hospital effects[J]. Leuk Lymphoma,2020,61(10):2365-2374.
[14] YILDIZ F, DURNALI A, ERASLAN E, et al.Outcomes of Autologous Stem Cell Transplantation (ASCT) in Relapsed/Refractory Germ Cell Tumors: Single Center Experience from Turkey[J].Urol J,2020,17(5):497-500.
[15] ESTCOURT L, STANWORTH S, DOREE C, et al. Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. Cochrane Database Syst Rev,2012,16;(5):CD004269.
[16] HEAL J M, BLUMBERG N.Optimizing platelet transfusion therapy[J]. Blood Rev,2004,18(3):149-165.
[17] NEVO S, FULLER A K, HARTLEY E, et al.Acute bleeding complications in patients after hematopoietic stem cell transplantation with prophylactic platelet transfusion triggers of 10 x 10(9) and 20 x 10(9) per L[J]. Transfusion,2007,47(5):801-812.
[18] ESTCOURT L J, STANWORTH S J, DOREE C, et al. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev,2015,11(11):CD010983.
[19] STRAUSS R G.Pretransfusion trigger platelet counts and dose for prophylactic platelet transfusions[J]. Curr Opin Hematol,2005,12(6):499-502.
[20] TOOR A A, CHOO S Y, LITTLE J A.Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation[J]. Bone Marrow Transplant,2000,26(3):315-320.
[21] 卢信彤. 我国血小板输注阈值研究的meta分析[J]. 临床输血与检验,2018,20(5):470-476.
[22] 刘丽娜, 穆士杰, 胡兴斌, 等. 血液病患者预防性血小板输注阈值的比较[J]. 临床输血与检验,2013,15(3): 206-209.
[23] TRIULZI D J.How well do platelets prevent bleeding?[J]. Hematology Am Soc Hematol Educ Program,2020,1:518-522.
[24] ANTHON C T, SIVAPALAN P, GRANHOLM A, et al.Prophylactic platelet transfusions in hospitalised patients with thrombocytopenia-Protocol for a systematic review with meta-analysis[J]. Acta Anaesthesiol Scand,2021,65(7):988-994.

自体造血干细胞移植中不同预处理方案与血小板输注的临床分析^*

Clinical Analysis of Platelet Transfusion for Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation with Different Conditioning Regimens

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

关于本刊

作者中心

在线期刊

访问统计

联系我们

[1]	敬媛媛, 王洁, 李冬妹, 王丽君, 范成艳, 贾延军. 免疫性血小板输注无效患者HLA和/或HPA抗体产生的影响因素分析[J]. 临床输血与检验, 2021, 23(6): 723-727.
[2]	唐雯, 袁君, 严京梅, 吴毅, 齐清, 栾建凤, 刘太香, 吴敏慧, 史丽莉, 冯晨晨, 薛敏. 抗体特异性预测方法克服HLA-Ⅰ类抗体所致血小板输注无效患者1例^*[J]. 临床输血与检验, 2021, 23(6): 797-799.
[3]	胡婷婷, 王诗铭, 王希文, 海艳秋, 孙婷. 肿瘤患者输注血小板发生不良反应影响因素分析[J]. 临床输血与检验, 2021, 23(4): 464-468.
[4]	王慧茹, 刘会兰. 非血缘脐血移植术后患者输血情况相关影响因素分析^*[J]. 临床输血与检验, 2021, 23(2): 162-166.
[5]	王皓, 郭兴莹, 张志波, 张新萍, 冀春红, 黄象艳. HLA与HPA配型不合导致血小板输注无效1例[J]. 临床输血与检验, 2020, 22(3): 334-336.
[6]	黄雪原, 陈秉宇, 周明, 马现君, 陈静, 许红, 蔡丹, 胡俊, 谢毓滨, 桂嵘, 王勇军. 血小板抗体检测的多中心临床应用调查——基于中国10家单位的2 338例病例对照研究[J]. 临床输血与检验, 2020, 22(2): 113-117.
[7]	李冬妹, 王洁, 敬媛媛, 单小燕, 贾延军. 血小板输注无效患者体内C1q-HLA抗体的临床意义[J]. 临床输血与检验, 2020, 22(2): 126-130.
[8]	周明, 陈洋, 王敏, 潘健, 王慧茹. 机采血小板储存损伤对临床疗效的影响^*[J]. 临床输血与检验, 2019, 21(2): 129-133.
[9]	任思婳, 金晶纯, 金丽, 周文玲. 国内外血小板输注现状的分析[J]. 临床输血与检验, 2019, 21(2): 217-221.
[10]	卢信彤. 我国血小板输注阈值研究的meta分析[J]. 临床输血与检验, 2018, 20(5): 470-475.
[11]	龚道方,龙海波,刘昭国,谭云洪. 临床276例次单采血小板输注效果及相关因素分析[J]. 临床输血与检验, 2018, 20(4): 365-367.
[12]	王淑英, 周文辉, 李新颖, 张扬丽, 牛国涛, 冯艳青. 肝病患者血小板输注情况调查分析[J]. 临床输血与检验, 2017, 19(4): 328-331.
[13]	任苓苓, 邵春燕, 卓海龙, 骆群. 322例患者输注配合性血小板的临床研究[J]. 临床输血与检验, 2017, 19(3): 246-248.
[14]	高磊. 特殊情况紧急抢救输ABO血型不合的血小板效果观察[J]. 临床输血与检验, 2016, 18(2): 106-107.
[15]	杜春红,徐佩琦,李红学. 血小板输注无效相关因素的研究进展*[J]. 临床输血与检验, 2016, 18(1): 86-90.