减低预处理强度异基因干细胞移植后红细胞输血减少：既往血红蛋白水平的预测价值

Decreased RBCTs after reduced intensity conditioning allogeneic stem cell transplantation: predictive value of prior Hb level.

作者信息

Ivanov V, Faucher C, Mohty M, Bilger K, Ladaique P, Sainty D, Arnoulet C, Chabannon C, Vey N, Camerlo J, Bouabdallah R, Maraninchi D, Bardou V J, Blaise D

机构信息

Unit of Transplantation and Cellular Therapy, Institut Paoli Calmettes, Université de la Méditerranée, Marseille, France.

出版信息

Transfusion. 2004 Apr;44(4):501-8. doi: 10.1111/j.1537-2995.2004.03317.x.

DOI:10.1111/j.1537-2995.2004.03317.x

PMID:15043564

Abstract

BACKGROUND

RBCT (RBCT) requirements of stem cell transplant (SCT) recipients are often substantial and may be related to transplant type.

STUDY DESIGN AND METHODS

An analysis was done of RBCT requirements and Hb recovery kinetic in the first 60 days after HLA-identical sibling allogeneic SCT in a series of 110 consecutive patients treated for various malignant diagnoses. Patients were prepared with either an antithymocyte globulin (ATG) and reduced intensity chemotherapy-based conditioning (RIC) (n=64) or a myeloablative conditioning regimens (MAC; n=46). Patients received marrow (n=64) or PBPCs (n=46).

RESULTS

Overall, intensity of conditioning regimen (RIC vs. MAC; p=0.0005) and graft source (PBPC vs. marrow; p<0.0001) independently predicted RBCT requirements. Hb recovery was accelerated after RIC when compared to MAC allo-SCT (p=0.02). In RIC patients, RBCTs were inversely correlated to Hb level before conditioning (p<0.0001) and the dose of ATG (p=0.009). Moreover, Hb level before allo-SCT significantly influenced Hb recovery kinetic after RIC but had no impact on RBCT requirements and Hb recovery after MAC.

CONCLUSION

Thus, RIC conditioning creates a different pattern of erythropoiesis recovery as compared to a MAC regimen and suggest a need for studies aimed at further reducing RBCT and accelerating Hb recovery.

摘要

背景

干细胞移植（SCT）受者对红细胞悬液（RBCT）的需求通常很大，且可能与移植类型有关。

研究设计与方法

对110例连续接受同种异体造血干细胞移植治疗各种恶性疾病的患者进行分析，观察其在人类白细胞抗原（HLA）匹配的同胞异基因SCT后60天内对RBCT的需求及血红蛋白（Hb）恢复动力学。患者采用抗胸腺细胞球蛋白（ATG）联合基于减低剂量化疗的预处理方案（RIC，n = 64）或清髓性预处理方案（MAC，n = 46）进行预处理。患者接受骨髓移植（n = 64）或外周血干细胞移植（PBPCs，n = 46）。

结果

总体而言，预处理方案的强度（RIC与MAC；p = 0.0005）和移植物来源（PBPC与骨髓；p < 0.0001）独立预测了RBCT的需求。与MAC异基因SCT相比，RIC后Hb恢复加快（p = 0.02）。在RIC患者中，RBCT与预处理前的Hb水平呈负相关（p < 0.0001）以及与ATG剂量呈负相关（p = 0.009）。此外，异基因SCT前的Hb水平显著影响RIC后Hb恢复动力学，但对MAC后的RBCT需求和Hb恢复无影响。