重组人促血小板生成素在多发性骨髓瘤患者自体外周血干细胞移植中的临床应用

Clinical application of recombinant human thrombopoietin in patients with multiple myeloma during autologous peripheral blood stem cell transplantation

目的探讨重组人促血小板生成素(recombinant human thrombopoietin,rhTPO)在多发性骨髓瘤(multiple myeloma,MM)患者自体外周血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)中的临床价值。方法分析2010年1月至2019年12月本中心收集的CD34+自体造血干细胞数目低于2×10^(6)/kg(患者体重)并完成APBSCT的MM患者的临床资料,比较单用粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)及G-CSF联合rhTPO在APBSCT中促进骨髓造血重建的差异。结果根据APBSCT期间应用造血生长因子的不同,将患者分为G-CSF组(n=39)和G-CSF+rhTPO组(n=53)。两组患者平均CD34+干细胞数量差异无统计学意义(P=0.149),G-CSF+rhTPO组中性粒细胞植入平均时间较G-CSF组缩短[(11.21±1.03)d vs(12.13±1.47)d,P=0.001],血小板植入速度较G-CSF组快[(12.66±2.35)d vs(15.36±5.79)d,P=0.008],平均血小板输注治疗量低于G-CSF组[(1.79±0.77)个治疗量vs(2.46±1.82)个治疗量,P=0.036],总体感染率和3~4级感染率也较G-CSF组低(34.0%vs 41.0%,P=0.041;5.7%vs 23.1%,P=0.001)。结论rhTPO在MM患者APBSCT中起重要作用,与G-CSF联合能加速骨髓造血重建,降低血小板输注量和严重感染发生率。

ObjectiveTo investigate the clinical value of recombinant human thrombopoietin(rhTPO)in patients with multiple myeloma(MM)during autologous peripheral blood stem cell transplantation(APBSCT).MethodsThe clinical data of MM patients with CD34+ stem cells less than 2×10^(6)/kg and completed APBSCT,collected by Beijing Chao-Yang Hospital,Capital Medical University from January 2010 to December 2019,were analyzed.The differences in efficacy between granulocyte colony-stimulating factor(G-CSF)alone and G-CSF combined with rhTPO on bone marrow hematopoietic reconstruction during APBSCT were compared.ResultsPatients were divided into the G-CSF group(n=39)and the G-CSF+rhTPO group(n=53)according to the application of hematopoietic growth factors during APBSCT.No significant difference in the average number of CD34+cells was found between the two groups(P=0.149).The average time of neutrophil engraftment in G-CSF+rhTPO group was shorter than that in G-CSF group[(11.21±1.03)d vs(12.13±1.47)d,P=0.001];the platelet engraftment was faster than G-CSF group[(12.66±2.35)d vs(15.36±5.79)d,P=0.008];the mean therapeutic doses of platelet transfusion was lower than G-CSF group[(1.79±0.77)doses vs(2.46±1.82)doses,P=0.036];the overall infection rate and grade 3/4 infection rate were also lower than those in G-CSF group(34.0%vs 41.0%,P=0.041;5.7%vs 23.1%,P=0.001).ConclusionsrhTPO plays an important role during APBSCT in MM patients,and the combination with G-CSF can accelerate bone marrow hematopoietic reconstruction,and reduce platelet infusion and the incidence of severe infection.