血液系统恶性疾病患者接受造血干细胞移植期间血小板减少相关新进展

Advances on thrombocytopenia in patients with hematological malignancies during hematopoietic stem cell transplantation

血液系统恶性疾病患者接受造血干细胞移植(HSCT)期间血小板减少,是影响移植疗效的重要因素之一,通常发生于移植预处理后骨髓抑制期与移植后期。患者接受HSCT后,其血小板减少主要与外周血液循环中血小板被破坏增加,以及骨髓中血小板产生不足相关。HSCT期间患者血小板减少的严重程度与移植物抗宿主病(GVHD)、巨细胞病毒(CMV)感染、输注CD34+细胞数量、供者类型相关。HSCT期间血小板减少的治疗药物包括:重组人血小板生成素(rhTPO)、血小板生成素受体激动剂(TPORA)、重组人白细胞介素(rhIL)-11等,通过综合治疗有利于血液系统恶性疾病患者HSCT后血小板植入,改善HSCT期间血小板减少。笔者拟就血液系统恶性疾病患者接受HSCT期间血小板减少的好发时期、原因和危险因素,以及治疗方案的最新研究进展进行阐述,以期为该病的诊治提供参考。

Thrombocytopenia is an important factor affecting the efficacy of hematopoietic stem cell transplantation(HSCT)in patients with hematological malignancies,which usually occurs in bone marrow suppression after the use of conditioning regimens and post-transplantation.The thrombocytopenia in patients with hematological malignancies during HSCT are associated with increased platelet destruction in peripheral circulation and deficiency of platelet production in the bone marrow.Thrombocytopenia related to graft-versus-host disease(GVHD),cytomegalovirus(CMV)infection,transplanted CD34+cells dose and types of donors.Treatments of thrombocytopenia in patients with hematological malignancies during HSCT include recombinant human thrombopoietin(rhTPO),thrombopoietin receptor agonist(TPORA),recombinant human interleukin(rhIL)-11,etc..These comprehensive treatments are conducive to platelet engraftment after HSCT and improve thrombocytopenia during HSCT in patients with hematological malignancies.This article summarizes the latest research progress in the following aspects:onset period,causes,risk factors,and treatment of thrombocytopenia in patients with hematological malignancies during HSCT,in order to provide references for the diagnosis and treatment of this disease.