造血干细胞移植相关血小板减少的处理

韩悦; 姚奕芳

doi:10.13201/j.issn.1004-2806.2020.01.003

造血干细胞移植相关血小板减少的处理

韩悦^,,
姚奕芳

- 苏州大学附属第一医院血液科(江苏苏州, 215006)
基金项目:
国家自然科学基金(No:81670132)

详细信息

通讯作者: 韩悦,苏州大学附一院血液科副主任、教授、博士生导师。担任中华医学会血液学分会血栓与止血学组副组长、中国免疫学会血液免疫学会委员、江苏省免疫学会理事、江苏省血液免疫学会副主任委员、中国抗癌协会血液分会委员、中国老年医学会血液学分会常务委员、江苏省医学会血液学分会委员、移植学组委员、中国整合血液病专委会委员、江苏省“医学重点人才”、“六大高峰人才”、“333高层次人才”、主持教育部科技进步一等奖、江苏省科技进步一等奖。E-mail:hanyuesz@163.com

中图分类号: R558.3

收稿日期: 2019-12-05

Management of thrombocytopenia associated with hematopoietic stem cell transplantation

HAN Yue^,,
YAO Yifang

More Information

Corresponding author: HAN Yue, E-mail: hanyuesz@163.com

Received Date: 05 December 2019

摘要

摘要: 造血干细胞移植是多种血液系统疾病治疗的有效手段,血小板减少是造血干细胞移植后常见并发症,国内外报道发生率为5%～37%[1]。其病因复杂,治疗难度大,是移植的主要不良预后因素之一[1-3]。造血干细胞移植后血小板减少的定义名目众多,大致可分为血小板重建延迟[2]以及继发性血小板减少[3],前者指移植+60天后血小板持续低于50×109/L,排除复发等其他因素;后者则指移植后血小板重建,连续7 d脱离输注并维持在50×109/L以上,
- 血小板减少 /
- 造血干细胞移植 /
- 处理
- thrombocytopenia /
- hematopoietic stem cell transplantation /
- management

HTML全文

参考文献(22)

[1]	Yamazaki R,Kuwana M,Mori T,et al.Prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation:associations with impaired platelet production and increased platelet turnover[J].Bone Marrow Transplant,2006,38:377-384.
[2]	Ramirez P,Brunstein CG,Miller B,et al.Delayed platelet recovery after allogeneic transplantation:a predictor of increased treatment-related mortality and poorer survival[J].Bone Marrow Transplant,2011,46:981-986.
[3]	Bruno B,Gooley T,Sullivan KM,et al.Secondary failure of platelet recovery after hematopoietic stem cell transplantation[J].Biol Blood Marrow Transplant,2001,7:154-162.
[4]	First LR,Smith BR,Lipton J,et al.Isolated thrombocytopenia after allogeneic bone marrow transplantation:existence of transient and chronic thrombocytopenic syndromes[J].Blood,1985,65:368-374.
[5]	Dominietto A,Raiola AM,van Lint MT,et al.Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants:graft-versus-host disease,donor type,cytomegalovirus infections and cell dose[J].Br J Haematol,2001,112:219-227.
[6]	Jansen J,Hanks SG,Akard LP,et al.Slow platelet recovery after PBPC transplantation from unrelated donors[J].Bone Marrow Transplant,2009,43:499-505.
[7]	Zhao X,Zhao X,Huo M,et al.Donor-Specific Anti-Human Leukocyte Antigen Antibodies Predict Prolonged Isolated Thrombocytopenia and Inferior Outcomes of Haploidentical Hematopoietic Stem Cell Transplantation[J].J Immunol Res,2017,2017:1043836.
[8]	Kong Y,Hu Y,Zhang XH,et al.Association between an Impaired Bone Marrow Vascular Microenvironment and Prolonged Isolated Thrombocytopenia after Allogeneic Hematopoietic Stem Cell Transplantation[J].Biol Blood Marrow Transplant,2014,20:1190-1197.
[9]	Chu T,Tang Y,Wang H,et al.Efficacy of recombinant factor VIIa for severe bleeding complicated by platelet transfusion refractoriness in patients with hematologic malignancies[J].Thromb Res,2017,160:14-18.
[10]	Nurden AT,Viallard JF,Nurden P.New-generation drugs that stimulate platelet production in chronic immune thrombocytopenic purpura[J].Lancet,2009,373:1562-1569.
[11]	van der Garde M,van Hensbergen Y,Brand A,et al.Thrombopoietin Treatment of One Graft in a Double Cord Blood Transplant Provides Early Platelet Recovery While Contributing to Long-Term Engraftment in NSG Mice[J].Stem Cells Dev,2015,24:67-76.
[12]	Han TT,Xu LP,Liu DH,et al.Recombinant human thrombopoietin promotes platelet engraftment after haploidentical hematopoietic stem cell transplantation:a prospective randomized controlled trial[J].Ann Hematol,2015,94:117-128.
[13]	Wang H,Huang M,Zhao Y,et al.Recombinant Human Thrombopoietin Promotes Platelet Engraftment and Improves Prognosis of Patients with Myelodysplastic Syndromes and Aplastic Anemia after Allogeneic Hematopoietic Stem Cell Transplantation[J].Biol Blood Marrow Transplant,2017,23:1678-1684.
[14]	Sun YQ,Kong Y,Zhang XH,et al.A novel recombinant human thrombopoietin for treating prolonged isolated thrombocytopenia after allogeneic stem cell transplantation[J].Platelets,2018,30:994-1000.
[15]	Bento L,Bastida JM,García-Cadenas I,et al.Thrombopoietin receptor agonists for severe thrombocytopenia afterallogeneic stem cell transplantation:Experience of the Spanish Group of Hematopoietic Stem Cell Transplant (GETH)[J].Biol Blood Marrow Transplant,2019,25:1825-1831.
[16]	De Latour RP,Chevret S,Ruggeri A,et al.Romiplostim in patients undergoing allogeneic stem cell transplantation:results of a phase I/II multicenter trial[J].Blood,2016,128:65.
[17]	Isaacs C,Robert NJ,Bailey FA,et al.Randomized placebo-controlled study of recombinant human interleukin-11 to prevent chemotherapy-induced thrombocytopenia in patients with breast cancer receiving dose-intensive cyclophosphamide and doxorubicin[J].J Clin Oncol,1997,15:3368-3377.
[18]	Liu K,Chen Y,Zeng Y,et al.Coinfusion of mesenchymal stromal cells facilitates platelet recovery without increasing leukemia recurrence in haploidentical hematopoietic stem cell transplantation:a randomized,controlled clinical study[J].Stem Cells Dev,2011,20:1679-1685.
[19]	Wang J,Yi Z,Wang S,et al.The effect of decitabine on megakaryocyte maturation and platelet release[J].Thromb Haemost,2011,106:337-343.
[20]	Zhou H,Hou Y,Liu X,et al.Low-dose decitabine promotes megakaryocyte maturation and platelet production in healthy controls and immune thrombocytopenia[J].Thromb Haemost,2015,113:1021-1034.
[21]	Zhou H,Qin P,Liu Q,et al.A prospective,multicenter study of low dose decitabine in adult patients with refractory immune thrombocytopenia[J].Am J Hematol,2019,94:1374-1381.
[22]	Yue H,Yaqiong T,Jia C,et al.Low-Dose Decitabine for Patients With Thrombocytopenia Following Allogeneic Hematopoietic Stem Cell Transplantation:A Pilot Therapeutic Study[J].JAMA Oncol,2015,1:249-251.