异基因造血干细胞移植后血小板减少的危险因素及艾曲泊帕治疗效果分析

Risk factors of thrombocytopenia after allogeneic hematopoietic stem cell transplantation and therapeutic effect of eltrombopag

目的探讨异基因造血干细胞移植(allo-HSCT)后血小板减少的危险因素及使用艾曲泊帕治疗效果分析。方法回顾性分析2014年1月至2020年12月于贵州医科大学附属医院行allo-HSCT后140例患者的完整临床资料,分为血小板减少组及造血重建良好组,每组70例,其中血小板减少组又分为原发性血小板减少(PT,n=14)及继发性血小板减少(SFPR,n=56)患者,分别比较各组临床特征与生存情况,并分析14例血小板减少患者使用艾曲泊帕的治疗疗效。结果多因素分析显示,移植前疾病未缓解和部分缓解、合并感染、首次确诊到移植时间>6个月、ABO血型不相合、输注单个核细胞数≤10×10^(8)/kg、发生急性移植物抗宿主病(GVHD)、EB病毒感染、巨细胞病毒(CMV)感染、使用抗病毒药物为allo-HSCT后血小板减少的独立危险因素(P<0.05)。血小板减少组3年总生存率(OS)、无进展生存率(PFS)均低于造血重建良好组(P<0.05),SFPR患者3年OS、PFS均低于PT患者(P<0.05)。艾曲泊帕在移植后血小板减少患者中使用治疗有效率为71.4%,治疗有效患者停药后血小板计数均在50×10^(9)/L以上,且无药物不良反应。结论可干预危险因素预防allo-HSCT后血小板减少,艾曲泊帕治疗allo-HSCT后血小板减少患者的临床疗效较好。

Objective To investigate the risk factors of thrombocytopenia after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and to analyze the therapeutic effect of Eltrombopag.Methods The clinical data of 140 patients who underwent allo-HSCT in the Affiliated Hospital of Guizhou Medical University from January 2014 to December 2020 were retrospectively analyzed.They were divided into the thrombocytopenia group and the good hematopoietic reconstruction group,with 70 patients in each group.The thrombocytopenia group was divided into primary thrombocytopenia(PT,n=14)and secondary thrombocytopenia(SFPR,n=56).The clinical characteristics and survival of each group were compared,and the therapeutic effect of Eltrombopag in 14 patients with thrombocytopenia was analyzed.Results The multivariate analysis showed that the disease was not completely relieved before transplantation,the infection was complicated,the time from the first diagnosis to the transplantation was more than 6 months,the ABO blood type was not matched,the number of mononuclear cells transfused was less than 10×10^(8)/kg,acute graft-versus-host disease(GVHD),EB virus infection,cytomegalovirus(CMV)infection,and use of antiviral drugs were independent risk factors for thrombocytopenia after allo-HSCT(P<0.05).The 3-year overall survival rate(OS)and progression-free survival rate(PFS)of thrombocytopenia group were lower than those of good hematopoietic reconstruction group(P<0.05),and the 3-year OS and PFS of SFPR patients were lower than those of PT patients(P<0.05).The effective rate of Eltrombopag in patients with thrombocytopenia after transplantation was 71.4%,and the platelet counts of patients with effective treatment were all above 50×10^(9)/L,and there was no adverse drug reaction.Conclusion The risk factors can be intervened to prevent thrombocytopenia after allo-HSCT,and the clinical effect of Eltrombopag on patients with thrombocytopenia after allo-HSCT is good.