重组人血小板生成素治疗同步放化疗实体瘤患者血小板减少的临床疗效观察

Clinical observation on recombinant human thrombopoietin for treatment of concurrent chemoradiation-induced thrombocytopenia in solid tumor patients

目的探讨重组人血小板生成素(recombinant human thrombopoietin,rhTPO)治疗实体瘤同步放化疗患者血小板(blood platelet,PLT)减少的治疗疗效和安全性。方法对38例患者采用同步放化疗后出现PLT<50×109/L的实体瘤患者采用rhTPO治疗,分析其血小板下降的特点、治疗疗效及药物不良反应。结果对于采用同步放化疗的实体瘤患者血小板降低发生在5.2±1.9天;胸骨和盆骨照射体积≥50%者用药后恢复至正常所需要的时间更长;采用rhTPO治疗后PLT恢复至≥75×109/L所需时间为6.1±2.4天,PLT恢复至≥100×109/L所需时间为7.9±2.5天;用药后出现肌肉关节痛3例(7.9%)。结论同步放化疗后的实体瘤患者特别是进行大面积胸骨及盆骨照射的肿瘤患者出现PLT下降程度更明显,持续时间长,rhTPO能有效地减少同步放化疗后PLT降低的程度和持续时间,促进PLT恢复,且患者不良反应轻,安全性好。

Objective To evaluate the efficacy and safety of recombinant human thrombopoietin （rhTPO） in the treatment of concurrent chemoradiation-induced thrombocytopenia with solid tumor. Methods Thirty-eight patients with platelet count 〈 50 × 10^9/L after concurrent chemoradiation received subcutaneous injection of rhTPO, then the characteris- tics of PLT count reductions, therapeutic effect and side-effect were analyzed. Results The thrombocytopenia with solid tumor often happened in （5. 2±1.9） d after concurrent chemoradiation. The minimal PLT count after concurrent chemoradiation was related to the radiation volume in treatment. The patients with radiation volume≥50% in breastbone or pel- vis took longer time to recover PLT count. It was found that the time of PLT count to recover to he more than 75 x 10^9/L and 100 × 10^9/L after concurrent chemoradiation was （6. 1±2.4） d and （7. 9 ±2. 5） d, respectively. There were sevenpatients who needed PIX transfllsion. Tile side-effect （ muscle and joint aches） rate was 7.9%. Conclusion The thrombocytopenia will be more obvlous ald last longer when patients with solid tumor receive of concurrent chenloradiation, especially those who with radiation volume ≥150% in breastbone or pelvis., rhTPO is capable of reducing the degree and duration of thrnmbocytopenia significantly as prornoting PLT recovery without severe side-effect for patients with solid tumor after concurrent chemoradiation.