含与不含抗胸腺细胞球蛋白的两种预处理方案早期毒性的比较

A comparative study on early toxicity of conditioning regimen with or without antithymocyte globulin

目的比较采用改良白消安／环磷酰胺（Bu／Cy）方案及改良Bu／Cy＋抗胸腺细胞球蛋白（ATG）方案进行预处理的异基因造血干细胞移植（HSCT）患者在预处理期间及移植后早期发生的相关毒性。方法100例血液系统恶性肿瘤患者中，应用改良Bu／Cy方案者（A组）42例，应用改良Bu／Cy＋ATG方案者（B组）58例，主要观察预处理期间及移植后早期出现的非感染性发热、腹泻、肝毒性、黏膜炎及血液系统毒性。结果A、B两组发热发生率分别为4．8％和81．0％，转氨酶升高发生率分别为59．5％和65．5％，胆红素升高发生率分别为16．7％和48．3％，腹泻发生率分别为59．5％和79．3％，黏膜炎发生率分别为45．2％和37．9％。白细胞进入零期的中位时间分别为＋3d和-3d；-10d内需输注红细胞及血小板的比例分别为11．9％和32．8％，16．7％和82．8％。结论含ATG的预处理方案组发热，腹泻，肝损害，白细胞、红细胞和血小板降低的发生率明显高于不含ATG的预处理方案组，这种改变很可能与ATG相关。

Objective To evaluate the toxicity of conditioning regimens of modified Bu/Cy ＋/- antithymocyte（ATG） in early stage after allogeneic hematopoietic stem eel1 transplantation （allo-HSCT）. Methods A hundred patients with hematological malignancies undergoing allo-HSCT were assessed. Fortytwo patients （group A） were conditioned with modified Bu/Cy regimen, 58 （group B） with modified Bu/Cy ＋ ATG regimen. The occurrence of toxicity during the early stage after transplantation was evaluated and compared, including non-infectious fever, diarrhea, hepatotoxieity, mucositis and hematological toxicity. Results In group A and B, the incidence of non-infectious fever was 4.8% vs 81.0% , transaminase elevation 59.5% vs 65.5% , bilirubin elevation 16.7% vs 48.3% , diarrhea 59.5% vs 79.3% and mncositis 45.2% vs 37.9% , respectively, white blood cells reached zero occurred at a median of ＋3 d and -3 d, the rate of red cell and platclet transfusion-dependence ,within l0 days before transplantation was 11.9% vs 32.8 and 16.7% vs 82.8% , respectively. Conclusions Significant higher incidence of non-infectious fever, diarrhea, hepatotoxicity, leucocytopenia,and transfusion dependence is found and considered to be related to the administration of ATG in the conditioning regimen.