兔抗人胸腺细胞免疫球蛋白用于血液病患者第二次异基因造血干细胞移植的安全性

Safety of rabbit anti-human thymocyte immunoglobulin in second allogeneic hematopoietic stem cell transplantation for patients with hematological diseases

目的探讨兔抗人胸腺细胞免疫球蛋白(rATG)第二次应用于异基因造血干细胞移植(allo-HSCT)的安全性。方法回顾性分析2008年4月至2021年8月在北京大学血液病研究所先后接受两次allo-HSCT且预处理方案均使用rATG的27例患者。观察自rATG应用开始10 d内(移植前5 d至移植后3 d)预处理相关不良反应(发热、腹泻、心律失常、血压下降、肝损伤、癫痫等)在首次、二次应用中的发生情况,评价rATG在二次allo-HSCT中的安全性。结果首次、二次allo-HSCT预处理期间自开始使用rATG至移植后3 d,不良反应发生率分别为96.3%、77.8%(P=0.043),发热发生率分别为81.5%、63.0%(P=0.129),腹泻发生率分别为59.3%、25.9%(P=0.013),肝功能异常发生率分别为22.2%、25.9%(P=0.750),其他事件(心律失常、血压下降、癫痫)的发生率分别为3.7%、18.5%(P=0.083)。两次rATG应用期间发生的不良反应经对症治疗后均好转,无治疗中断发生。此外,在首次移植和二次移植应用rATG当天患者淋巴细胞计数的均数分别为0.5×10^(9)/L、0.3×10^(9)/L(P=0.038)。结论rATG用于第二次allo-HSCT没有增加预处理早期不良反应的发生率。

Objective To look into the security of a second allogeneic hematopoietic stem cell transplantation(allo-HSCT)using rabbit anti-human thymocyte immunoglobulin(rATG).Methods Twenty-seven patients who used rATG in the first and second allo-HSCT at the Institute of Hematology,Peking University were enrolled in the study.Experienced toxicities associated with the conditioning protocol within 10 days(-5 d to+3 d)following the beginning of the rATG application,including fever,diarrhea,arrhythmia,reduced blood pressure,liver damage,seizures,and other problems.ResultsThe overall incidence of conditioning regimen early adverse reactions during the first transplantation and the second allo-HSCT conditioning regimen was 96.3%and 77.8%(P=0.043).Fever rates were 81.5%and 63.0%(P=0.129),diarrhea rates were 59.3%and 25.9%(P=0.013),liver damage rates were 22.2%and 25.9%(P=0.75),and the rates of other events(cardiac arrhythmia,low blood pressure,and epilepsy)were 3.7%and 18.5%(P=0.083).Adverse reactions that occurred during both the first and second course of rATG applications have been improved with symptomatic treatment,and no treatment interruptions occurred.Conclusion Reusing rATG in a second transplant was risk-free and did not result in higher early toxicities.