祛铁治疗改善恶性血液病患者造血干细胞移植后造血功能的临床分析

Iron chelation therapy improves hematopoiesis in patients with hematological malignancy after hematopoietic stem cell transplantation

目的探讨祛铁治疗对异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后铁过载的恶性血液病患者造血功能的影响和安全性。方法回顾性分析本院2019年5月至2021年6月接受allo-HSCT后铁过载的恶性血液病患者38例的资料。根据是否使用祛铁治疗分成2组,其中治疗组21例(采用地拉罗司口服祛铁治疗),对照组17例(未采用祛铁治疗)。观察两组患者的血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)、白细胞(white blood cell,WBC)计数及血清铁蛋白(serum ferritin,SF)水平的变化,并观察用药期间的不良反应。结果在治疗后2、4、8周,与对照组相比,治疗组Hb、PLT水平较基线有明显升高(P<0.05);而WBC水平的变化与对照组差异无统计学意义(P>0.05)。治疗组在4、8周SF水平较基线下降,与对照组相比差异有统计学意义[-867(-1918~477)μg/L vs 436(-408~467)μg/L(P<0.001),-1243(-2784~364)μg/L vs 541(-674~578)μg/L(P<0.001)]。治疗组患者均未发生严重的胃肠道症状及肝肾功能损害等不良反应。结论祛铁治疗能够有效改善异基因造血干细胞移植后铁过载的恶性血液病患者的造血功能,且安全性良好。

Objective To investigate the effect and safety of iron chelation therapy on hematopoiesis in hematological malignancy patients with iron overload after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The clinical data of 38 hematological malignancy patients who suffered from iron overload after allo-HSCT and were treated in our hospital from May 2019 to June 2021 were retrospectively reviewed and analyzed.According to receiving iron chelation or not,they were divided into treatment group(n=21,oral administration of deferasirox)and control group(n=17,no iron chelation).The changes of hemoglobin(Hb)level,platelet(PLT)count,white blood cell(WBC)count and serum ferritin(SF)level were compared between the 2 groups,and the adverse reactions during administration were observed as well.Results At 2,4 and 8 weeks after treatment,Hb level and PLT count in the treatment group were significantly improved from baseline as compared with the control group(P<0.05),but the WBC count showed no significant difference between the 2 groups(P>0.05).SF levels in the treatment group was decreased from baseline at 4 and 8 weeks,significantly lower than those of the control group[-867(-1918~477)vs 436(-408~467)μg/L,P<0.001;-1243(-2784~364)vs 541(-674~578)μg/L,P<0.001].None of the patients in the treatment group developed serious gastrointestinal symptoms or severe damage to liver and kidney functions.Conclusion Iron chelation therapy can effectively improve the hematopoiesis,with satisfactory safety,in the patients suffering from iron overload after allo-HSCT.