重组人血小板生成素治疗老年人急性髓细胞白血病化疗后重度血小板减少20例

Clinical study on recombinant human thrombopoietin in the treatment of severe thrombocytopenia induced by chemotherapy in elder patients with acute myeloid leukemia

目的研究重组人血小板生成素（rhTPO）对老年急性髓细胞白血病（AML）化疗后所致血小板减少的治疗效果及患者不良反应。方法20例老年AML完全缓解（CR）患者予连续2个周期巩固化疗。第1个周期（对照周期）出现重度血小板减少后仪输注血小板悬液；第2个周期（治疗周期）在前述治疗基础上，当血小板≤50×10^9／L时每日给予rhTPO 1．01μg／kg，皮下注射，连用14d，或血小板计数≥80×10^9／L后停药。观察患者疗效及不良反应。结果治疗周期血小板〈100×10^9／L的持续时间为（23．1±4．5）d，≤20×10^9／L的持续时间为（6．8±2．6）d，与对照周期的（25．8±5．7）d、（11．7±3．2）d比较，差异有统计学意义（P〈0．005）；血小板最低值治疗周期为（13．2±4．4）×10^9／L与对照周期的（12．2±3．1）×10^9／L比较，差异无统计学意义（P=0．0967）；治疗周期血小板最高值为（239．3±48．7）×10^9／L，显著高于对照周期的（163．5±32．4）×10^9／L（P〈0．005）；治疗周期血小板输注量为（22．8±6．8）U，明显少于对照周期的（30．0±6．3）U（P〈0．05）；血红蛋白、向细胞计数、尿常规、肝功能、肾功能及凝血功能治疗周期与对照周期比较差异无统计学意义（P=0．0872）。治疗周期5例患者出现不良反应（25％），均为一过性，未出现血栓栓塞事件。结论在老年AML巩固化疗中应用rhTPO，可以明显加速血小板的恢复，减轻化疗引起的血小板降低程度和持续时间，减少输注血小板，并且安全有效，值得临床推广应用。

Objective To study the efficacy and safety of recomhinant human thrombopoietin （rhTPO） in the treatment of thrombocytopenia induced by chemotherapy in elder patients with acute myeloid leukemia. Methods 20 elder patients with acute myeloid leukemia who got CR received two cycles of consolidation chemotherapy. In the first cycle of chemotherapy（control cycle）, they were transfused with platelet suspensions when they developed severe thrombocytopenia; In the second cycle of chemotherapy （treatment cycle）, they were given subeutaneous injection of rhTPO 1.0 μg.kg^-2.d^-1 for 14 days or until platelet count ≥80×10^9/L with the treatment above all when platelet count ≤50×10^9/L. The efficaey and safety were evaluated, Results The duration of Pit count 〈100×10^9/L in the treatment cycle and the control cycle was （23.1±4.5）d and （25.8± 5.7） d （P 〈0.005）; the duration of Pit eount≤20×10^9/L in the treatment cycle and in the control cycle was （6.8±2.6） d and （11.7±3.2） d （P 〈0.005）. The minimal Ph count of the treatment cycle and the control cycle were （13.2±4.4）×10^9/L and （12.2±3.1）×10^9/L （P =0.0967） respectively, and the maximal Pit count after its recovery were （239.3±48.7）×10^9/L and （163.5 ±32.4）×10^9/L （P〈0.005） respectively. Platelet transfusion was （22.8±6,8） U in the treatment group, it was significantly lower than that in the control group （30.0±6.3） U（P〈0.05）. The changes of hemoglobin content, white blood cell count, Urine routine, the function of liver and kidney, the function of blood coagulation after chemotherapy in both groups were no obvious（P =0.0872）. Transient adverse reaction was observed in 5 patients （25 %）. No thrombotic incident had occurred. Conclusion rhTPO can significantly accelerate PLT recovery, reduce the degree and duration of thromboeytopenia induced by chemotherapy, and reduce platelet transfusion in the treatment of consolidation chemotherapy for the elder patients with acute myeloid leukemia. It is safe and can be recommended to use widely.