BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic v...BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic variceal ligation,and most of them have lower platelet counts,which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders.Unfortunately,there is no defined treatment modality for CLD-induced thrombocytopenia.Recombinant human thrombopoietin(rhTPO)is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy;however,there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLDassociated thrombocytopenia undergoing invasive procedures.METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021.Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia.Adverse events related to treatment,such as bleeding,thrombosis,and disseminated intravascular coagulation,were also investigated.RESULTS Among the enrolled patients,78(78%)showed a platelet count increase after rhTPO use,while 22(22%)showed no significant change in platelet count.The mean platelet count after rhTPO treatment in all patients was 101.53±81.81×10^(9)/L,which was significantly improved compared to that at baseline(42.88±16.72×10^(9)/L),and this difference was statistically significant(P<0.001).In addition,patients were further divided into three subgroups according to their baseline platelet counts(<30×10^(9)/L,30-50×10^(9)/L,>50×10^(9)/L).Subgroup analyses showed that the median platelet counts after treatment were significantly higher(P<0.001,all).Ninety(90%)patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO.No serious adverse events related to rhTPO treatment were observed.Overall,rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.CONCLUSION rhTPO can improve platelet count,reduce the risk of bleeding,and decrease the platelet transfusion rate,which may promote the safety of invasive procedures and improve overall survival of patients with CLD.展开更多
目的:分析比较重组人血小板生成素(rhTPO)与重组人白介素-11(rhIL-11)在急性白血病化疗后血小板(PLT)减少患者治疗中的效果。方法:回顾分析安徽医科大学第一附属医院180例急性白血病化疗后并发血小板减少症患者,其中50例使用rhTPO治疗...目的:分析比较重组人血小板生成素(rhTPO)与重组人白介素-11(rhIL-11)在急性白血病化疗后血小板(PLT)减少患者治疗中的效果。方法:回顾分析安徽医科大学第一附属医院180例急性白血病化疗后并发血小板减少症患者,其中50例使用rhTPO治疗且未进行血小板输注的为A组,50例使用rhTPO治疗且进行血小板输注的为B组,40例使用rhIL-11治疗且未进行血小板输注的为C组,40例使用rhIL-11治疗且进行血小板输注的为D组,比较各组患者PLT在20×10^(9)/L以下持续天数、PLT恢复至大于100×10^(9)/L所需天数以及不同出血程度的发生率。结果:A组PLT<20×10^(9)/L水平持续时间显著短于C组(3.72±1.14 d vs 4.93±1.33 d,P<0.001),与B组差异无统计学意义(P>0.005)。B组PLT<20×10^(9)/L水平持续的天数显著短于D组(3.06±0.91 d vs 4.65±0.98 d,P<0.001),而C组和D组持续的天数差异无统计学意义(P>0.05)。A组PLT恢复至100×10^(9)/L的时间显著短于C组(13.46±1.67 d vs 16.85±2.13 d,P<0.05),而与B组差异无统计学意义(P>0.05);B组PLT恢复至100×10^(9)/L的天数显著短于D组(13.36±1.49 d vs 16.18±1.78 d,P<0.001),而C组和D组所需天数差异无统计学意义(P>0.05)。B组的高出血风险发生率明显低于A组(22%vs 44%,P<0.05),D组的高出血风险发生率明显低于C组(32%vs 65%,P<0.05),A组的高出血风险发生率明显低于C组(44%vs 65%,P<0.05),B组的高出血风险发生率低于D组(22%vs 32.5%),差异无统计学意义(P>0.05)。结论:在急性白血病化疗后血小板减少患者的治疗中,与rhIL-11比较,rhTPO能明显缩短患者血小板处于极低水平状态及升至正常的时间,而血小板的输注不能加快患者血小板升高至安全范围的时间,也不能缩短患者处在低血小板水平持续的时间,但可以减少患者高出血风险事件的发生率。展开更多
Background The management of patients with refractory immune thrombocytopenia （ITP） is challenging, as there is no standard treatment option. The aim of this study was to investigate the efficacy of recombinant huma...Background The management of patients with refractory immune thrombocytopenia （ITP） is challenging, as there is no standard treatment option. The aim of this study was to investigate the efficacy of recombinant human thrombopoietin （rhTPO） in combination with cyclosporin A （CsA） for the management of patients with corticosteroid-resistant primary ITP.展开更多
目的：研究重组人促血小板生成素（rhTPO）治疗急性髓系白血病（AML）患者化疗后血小板减少的疗效及不良反应发生情况。方法51例AML化疗后出现血小板减少的患者，随机分为实验组（26例，给予rhTPO治疗）与对照组[25例，给予重组人白细...目的：研究重组人促血小板生成素（rhTPO）治疗急性髓系白血病（AML）患者化疗后血小板减少的疗效及不良反应发生情况。方法51例AML化疗后出现血小板减少的患者，随机分为实验组（26例，给予rhTPO治疗）与对照组[25例，给予重组人白细胞介素-11（rhIL-11）治疗]。比较两组患者化疗后血小板恢复的水平、血小板〈50＆#215;109/L的持续天数、恢复至75＆#215;109/L所需天数和恢复至100＆#215;109/L所需天数，以及两组的不良反应发生率。结果治疗后，实验组血小板水平显著高于对照组（P〈0.05），血小板〈50＆#215;109/L的持续天数及恢复至75＆#215;109/L、100＆#215;109/L所需的天数明显少于对照组（P〈0.05）；实验组不良反应发生率低于对照组（7.7% VS 40.0%）（P〈0.05）。结论rhTPO能有效促进AML患者化疗后的血小板恢复，且不良反应发生率低。展开更多
Background:Chemotherapy plus granulocyte colony-stimulating factor (GCSF) regimen is one of the available approaches to mobilize peripheral blood progenitor cells (PBPCs).It causes thrombocytopenia and delays leukaphe...Background:Chemotherapy plus granulocyte colony-stimulating factor (GCSF) regimen is one of the available approaches to mobilize peripheral blood progenitor cells (PBPCs).It causes thrombocytopenia and delays leukapheresis.This study aimed to evaluate the role of recombinant human thrombopoietin (rhTPO) before mobilization chemotherapy in facilitating leukapheresis in patients with lymphoma.Methods:In this randomized open-label phase 2 trial, patients were randomly assigned in a 1:2 ratio to receive mobilization with rhTPO plus GCSF in combination with chemotherapy (the rhTPO plus GCSF arm) or GCSF alone in combination with chemotherapy (the GCSF alone arm).The recovery of neutrophils and platelets and the amount of platelet transfusion were monitored.Results:Thirty patients were enrolled in this study between March 2016 and August 2018. Patients in the rhTPO plus GCSF arm (n = 10) had similar platelet nadir after mobilization chemotherapy (P=0.878) and similar amount of platelet transfusion (median 0 vs.1 unit,P=0.735) when compared with the GCSF alone arm (n = 20). On the day of leukapheresis, the median platelet count was 86 ×10^(9)/L (range 18-219) among patients who received rhTPO and 73 ×10^(9)/L (range 42-197) among those who received GCSF alone (P=0.982). After the use of rhTPO, the incidence of platelet count <75 ×10^(9)/L on the day of leukapheresis did not decrease significantly (30.0% vs. 50.0%,P=0.297).Platelet recovery after PBPC transfusion was more rapid in the rhTPO plus GCSF arm (median 8.0 days [95% confidence interval 2.9-13.1] to platelets ≥50 ×10^(9)/L vs. 11.0 days [95% confidence interval 8.6-13.4],P=0.011).The estimated total cost of the mobilization and reconstitution phases per patient was similar between the two treatmtent groups (P=0.362 andP=0.067,respectively).Conclusions:Our findings indicate that there was no significant clinical benefit of rhTPO use in facilitating mobilization of progenitor cells,but it may promote platelet recovery in the reconstitution phase after high-dose therapy.Trial registration:This trial has been registered in Clinicaltrials.gov as NCT03014102.展开更多
基金Supported by the Science and Technology Development Plan of Suzhou,Jiangsu Province,China,No.SYS2020009.
文摘BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic variceal ligation,and most of them have lower platelet counts,which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders.Unfortunately,there is no defined treatment modality for CLD-induced thrombocytopenia.Recombinant human thrombopoietin(rhTPO)is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy;however,there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLDassociated thrombocytopenia undergoing invasive procedures.METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021.Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia.Adverse events related to treatment,such as bleeding,thrombosis,and disseminated intravascular coagulation,were also investigated.RESULTS Among the enrolled patients,78(78%)showed a platelet count increase after rhTPO use,while 22(22%)showed no significant change in platelet count.The mean platelet count after rhTPO treatment in all patients was 101.53±81.81×10^(9)/L,which was significantly improved compared to that at baseline(42.88±16.72×10^(9)/L),and this difference was statistically significant(P<0.001).In addition,patients were further divided into three subgroups according to their baseline platelet counts(<30×10^(9)/L,30-50×10^(9)/L,>50×10^(9)/L).Subgroup analyses showed that the median platelet counts after treatment were significantly higher(P<0.001,all).Ninety(90%)patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO.No serious adverse events related to rhTPO treatment were observed.Overall,rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.CONCLUSION rhTPO can improve platelet count,reduce the risk of bleeding,and decrease the platelet transfusion rate,which may promote the safety of invasive procedures and improve overall survival of patients with CLD.
文摘目的:分析比较重组人血小板生成素(rhTPO)与重组人白介素-11(rhIL-11)在急性白血病化疗后血小板(PLT)减少患者治疗中的效果。方法:回顾分析安徽医科大学第一附属医院180例急性白血病化疗后并发血小板减少症患者,其中50例使用rhTPO治疗且未进行血小板输注的为A组,50例使用rhTPO治疗且进行血小板输注的为B组,40例使用rhIL-11治疗且未进行血小板输注的为C组,40例使用rhIL-11治疗且进行血小板输注的为D组,比较各组患者PLT在20×10^(9)/L以下持续天数、PLT恢复至大于100×10^(9)/L所需天数以及不同出血程度的发生率。结果:A组PLT<20×10^(9)/L水平持续时间显著短于C组(3.72±1.14 d vs 4.93±1.33 d,P<0.001),与B组差异无统计学意义(P>0.005)。B组PLT<20×10^(9)/L水平持续的天数显著短于D组(3.06±0.91 d vs 4.65±0.98 d,P<0.001),而C组和D组持续的天数差异无统计学意义(P>0.05)。A组PLT恢复至100×10^(9)/L的时间显著短于C组(13.46±1.67 d vs 16.85±2.13 d,P<0.05),而与B组差异无统计学意义(P>0.05);B组PLT恢复至100×10^(9)/L的天数显著短于D组(13.36±1.49 d vs 16.18±1.78 d,P<0.001),而C组和D组所需天数差异无统计学意义(P>0.05)。B组的高出血风险发生率明显低于A组(22%vs 44%,P<0.05),D组的高出血风险发生率明显低于C组(32%vs 65%,P<0.05),A组的高出血风险发生率明显低于C组(44%vs 65%,P<0.05),B组的高出血风险发生率低于D组(22%vs 32.5%),差异无统计学意义(P>0.05)。结论:在急性白血病化疗后血小板减少患者的治疗中,与rhIL-11比较,rhTPO能明显缩短患者血小板处于极低水平状态及升至正常的时间,而血小板的输注不能加快患者血小板升高至安全范围的时间,也不能缩短患者处在低血小板水平持续的时间,但可以减少患者高出血风险事件的发生率。
文摘Background The management of patients with refractory immune thrombocytopenia （ITP） is challenging, as there is no standard treatment option. The aim of this study was to investigate the efficacy of recombinant human thrombopoietin （rhTPO） in combination with cyclosporin A （CsA） for the management of patients with corticosteroid-resistant primary ITP.
文摘目的：研究重组人促血小板生成素（rhTPO）治疗急性髓系白血病（AML）患者化疗后血小板减少的疗效及不良反应发生情况。方法51例AML化疗后出现血小板减少的患者，随机分为实验组（26例，给予rhTPO治疗）与对照组[25例，给予重组人白细胞介素-11（rhIL-11）治疗]。比较两组患者化疗后血小板恢复的水平、血小板〈50＆#215;109/L的持续天数、恢复至75＆#215;109/L所需天数和恢复至100＆#215;109/L所需天数，以及两组的不良反应发生率。结果治疗后，实验组血小板水平显著高于对照组（P〈0.05），血小板〈50＆#215;109/L的持续天数及恢复至75＆#215;109/L、100＆#215;109/L所需的天数明显少于对照组（P〈0.05）；实验组不良反应发生率低于对照组（7.7% VS 40.0%）（P〈0.05）。结论rhTPO能有效促进AML患者化疗后的血小板恢复，且不良反应发生率低。
基金This work was supported by Beijing Hope Run Special Fund of Cancer Foundation of China(LC2016B03)。
文摘Background:Chemotherapy plus granulocyte colony-stimulating factor (GCSF) regimen is one of the available approaches to mobilize peripheral blood progenitor cells (PBPCs).It causes thrombocytopenia and delays leukapheresis.This study aimed to evaluate the role of recombinant human thrombopoietin (rhTPO) before mobilization chemotherapy in facilitating leukapheresis in patients with lymphoma.Methods:In this randomized open-label phase 2 trial, patients were randomly assigned in a 1:2 ratio to receive mobilization with rhTPO plus GCSF in combination with chemotherapy (the rhTPO plus GCSF arm) or GCSF alone in combination with chemotherapy (the GCSF alone arm).The recovery of neutrophils and platelets and the amount of platelet transfusion were monitored.Results:Thirty patients were enrolled in this study between March 2016 and August 2018. Patients in the rhTPO plus GCSF arm (n = 10) had similar platelet nadir after mobilization chemotherapy (P=0.878) and similar amount of platelet transfusion (median 0 vs.1 unit,P=0.735) when compared with the GCSF alone arm (n = 20). On the day of leukapheresis, the median platelet count was 86 ×10^(9)/L (range 18-219) among patients who received rhTPO and 73 ×10^(9)/L (range 42-197) among those who received GCSF alone (P=0.982). After the use of rhTPO, the incidence of platelet count <75 ×10^(9)/L on the day of leukapheresis did not decrease significantly (30.0% vs. 50.0%,P=0.297).Platelet recovery after PBPC transfusion was more rapid in the rhTPO plus GCSF arm (median 8.0 days [95% confidence interval 2.9-13.1] to platelets ≥50 ×10^(9)/L vs. 11.0 days [95% confidence interval 8.6-13.4],P=0.011).The estimated total cost of the mobilization and reconstitution phases per patient was similar between the two treatmtent groups (P=0.362 andP=0.067,respectively).Conclusions:Our findings indicate that there was no significant clinical benefit of rhTPO use in facilitating mobilization of progenitor cells,but it may promote platelet recovery in the reconstitution phase after high-dose therapy.Trial registration:This trial has been registered in Clinicaltrials.gov as NCT03014102.
