rhG-CSF联合rhTPO促进异基因造血干细胞移植后造血重建的临床研究

Clinical study on hematopoietic reconstitution in allo-hematopoietic stem cell transplant patients with leukemia accelerate by rhG-CSF and rhTPO

目的探讨重组人粒细胞刺激因子(recombinant human-granulocyte colony sti mulating factor,rhG-CSF)和重组人血小板生成素(recombinant human-thrombopoietin,rhTPO)促进异基因造血干细胞移植后造血功能重建的作用。方法选取15例异基因造血干细胞移植患者,其中同胞间全相合移植6例,非血缘全相合移植7例,半相合移植2例,于移植后+1d予以rhG-CSF(300μg/d)和rhTPO(15 000u/d)治疗,观察患者造血重建的时间和相关并发症发生情况。结果患者于移植+15d(+8^+20d)N>0.5×109/L,移植+19d(+11^+23d)PLT>30×109/L,提示造血功能重建。移植+30d复查短串联重复序列(STR)检测,均提示重建造血为供者造血。随访至今,所有患者造血稳定重建。15例患者中10例出现感染、发热;15例患者均出现不同程度的皮下出血,多表现为皮肤淤点淤斑,2例患者出现鼻出血;3例患者在造血重建前夕出现全身骨痛。3例出现Ⅱ度以下急性移植物抗宿主病(GVHD),2例患者出现轻度的慢性GVHD。结论rhG-CSF联合rhTPO促进异基因造血干细胞移植后造血重建疗效肯定,减少移植感染、出血等并发症的发生率,缩短层流病房住院日,减少血小板、红细胞等血液制品的输入量,降低移植费用。

Objective To explore the clinical effect of hematopoietic reconstitution in allo-hematopoietic stem cell transplant patients with leukemia accelerated by recombinant human-granulocyte colony stimulating factor （rhG-CSF） and recombinant human-thrombopoietin （rhTPO）. Methods Fifteen leukemia patients received rhG-CSF （300μg/d） and rhTPO （15 000u/d） from ld until WBC recovering to 4.0 ×10^99/L and platelet recovering to 75 ×10^99/L. Results The median days of neutrophile granulocyte up to 0.5 ×10^99/L were 15d and the median days of PLT up to 30 ×10^99/L were 19d. STR method display donor haemopoiesis on 30d. Some patients had fever, subcutaneous hemorrhage and nasal bleeding. Three patiens had ostalgia before hematopoietic reconstitution. Three patiens had Ⅰ / Ⅱ aGVHD and two patiens had slight cGVHD. Conclusion RhG-CSF and rhTPO administrtion after allo-HSCT can obviously accelerate the recovery of WBC and PLT, reduce the risk of infection and haemorrhage, and shorten the time of hospitalization.