干细胞移植后免疫性血小板减少症药物治疗的系统评价

Systematic review of medication for immune thrombocytopenia after stem cell transplantation

目的系统评价药物治疗造血干细胞移植后免疫性血小板减少症的临床疗效以及安全性。方法计算机检索PUBMED(1950~2016)、COCHRAN E CENTRAL(2016年第6期)、CBM(1979~2016)、CNKI(1976~2016)、VIP(1989~2016),按纳入排除标准筛选文献,描述性分析药物治疗造血干细胞移植后免疫性血小板减少症的临床疗效以及安全性。结果共纳入18个研究,均为病例报告。这些研究中涉及患者年龄从8个月到68岁不等,共有儿童患者13例,成人患者31例,患者年龄未知1例。45名患者均进行了造血干细胞移植,包括自体造血干细胞移植和异体造血干细胞移植。但在移植0.13~68.80个月后他们均出现了不同程度的难治性免疫性血小板减少症在治疗移植后免疫性血小板减少症时,患者使用IVIG时,总缓解率为31.30%(5/16例),激素类药物的缓解率为21.30%(5/23例),利妥昔单抗的缓解率为50.00%(8/16例),罗米司亭的缓解率为88.23%(15/17例),间充质干细胞(MSC)疗法的缓解率为100%(3/3例),长春新碱的缓解率为100%(1/1例),环孢素A的缓解率为0(0/1例),艾曲波帕的缓解率为100%(1/1例)。结论在治疗移植后血小板减少症时可以首先考虑一线治疗,即IVIG和激素类药物。如果一线药物效果不理想,则可选择罗米司亭和利妥昔单抗。如果仍不理想,可选用MSC疗法、长春新碱及艾曲波帕。

Objective To systematically evaluate the effectiveness of medication for immune thrombocytopenia after stem cell transplantation.Methods The literatures about medication of immune thrombocytopenia after stem cell transplantation were selected from the databases of Pub Med（ 1950- 2016）,COCHARNE LIBRARY CENTRAL（ Issue 3th,2012）,CBM（ 1979- 2014）,CNKI（ 1976- 2014）, VIP（ 1989- 2014）,according to the inclusion and exclusion criteria. The clinical efficacy and the safety of the medication were evaluated by descriptive analysis.Results A total of 18 reports were enrolled in this study, which included 45 patients,aged from 8 months to 68 years old. There were 13 children and 31 adults,but the age of 1 patient was unknown. A total of45 patients were conducted a hematopoietic stem cell transplantation,including autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation. But 0. 13 to 68. 80 months later,they appeared different degree of refractory immune thrombocytopenia after transplantation. In the treatment of immune thrombocytopenia after transplantation,the drugs IVIG,steroids,rituximab,romiplostim,mesenchymal stem cells（ MSC）,Vincristine,cyclosporin A,and eltrombopag were effective and the total remission rates were31. 30%（ 5 /16 cases）,21. 30%（ 5 /23 cases）,50. 00%（ 8 /16 cases）,88. 23%（ 15 /17 cases）,100%（ 3 /3 cases）,100%（ 1 /1 case）,0（ 0 /1 case） and 100%（ 1 /1 case） respectively. Conclusion IVIG and steroids are suggested to be the first- line therapy in the treatment of thrombocytopenia after transplantation. If the outcome of the first- line therapy is not ideal,romiplostim and rituximab are recommended,while MSC therapy,vincristine and eltrombopag would be the last choices.