Chen Jie, Zhu Kang-er, Zhang Tao, Zhong Jun, Chen Sheng-ting, Zeng Hui-lan
Department of Hematology, the First Affiliated Hospital, Jinan University, Guangzhou 510632, China.
Zhonghua Nei Ke Za Zhi. 2007 Feb;46(2):140-2.
To explore the safety and efficacy of low dose heparin for the prevention of hepatic veno-occlusive disease (VOD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) conditioned with busulfan and cyclophosphamide (BU-CY2) and the ideal time frame of the heparin administration.
From April 1997 to December 2005, 134 patients (75 male, 59 female; median age 25 years old) were transplanted in our bone marrow transplantation unit. All patients were conditioned with BU-CY2 or busulfan-based regimen and scheduled to receive a continuous injection of heparin at a dose of 100 IUxkg-1xd-1. The patients were divided into different groups: 87 patients received related donor transplantation and 47 patients unrelated donor transplantation; 40 patients had abnormal liver function prior to transplantation and the remaining 94 patients normal liver function; 68 patients received heparin from day -7 to day +21 post HSCT and the other 66 patients from day -7 to day +14.
All 134 patients had sustained engraftment. The median time for neutrophils to reach 0.5 x 10(9)/L and for platelets to reach 20x10(9)/L were 12 days (range 9-28) and 20 days (range 6-65), respectively. The disease-free survival at day +100 for leukemia patients was 82.2% (97/118). None of 134 patients developed VOD (0%), including 10 patients with class 3 thalassemia major. The incidence and severity of clinical bleeding events in 15 patients monitored with prothrombin time and activated partial thromboplastin time is comparable with those not monitored.
It is suggested that low dose heparin alone is effective and safe for the prophylaxis of VOD following allo-HSCT conditioned with BU-CY regimen. Shortening the duration of administering heparin from -7 d to +21 d to -7 d to +14 d does not affect the effectiveness of low dose heparin to prevent VOD.
探讨低剂量肝素预防经白消安和环磷酰胺（BU - CY2）预处理的异基因造血干细胞移植（allo - HSCT）后肝静脉闭塞病（VOD）的安全性和有效性，以及肝素给药的理想时间范围。
1997年4月至2005年12月，134例患者（男75例，女59例；中位年龄25岁）在我们的骨髓移植科接受移植。所有患者均采用BU - CY2或基于白消安的方案进行预处理，并计划接受剂量为100 IU·kg⁻¹·d⁻¹的肝素持续注射。患者分为不同组：87例接受相关供体移植，47例接受无关供体移植；40例移植前肝功能异常，其余94例肝功能正常；68例患者在HSCT后第 - 7天至第 + 21天接受肝素治疗，另外66例患者在第 - 7天至第 + 14天接受肝素治疗。
134例患者均实现持续植入。中性粒细胞计数达到0.5×10⁹/L和血小板计数达到20×10⁹/L的中位时间分别为12天（范围9 - 28天）和20天（范围6 - 65天）。白血病患者在第 + 100天的无病生存率为82.2%（97/118）。134例患者均未发生VOD（0%），包括10例重型β地中海贫血患者。15例通过凝血酶原时间和活化部分凝血活酶时间监测的患者临床出血事件的发生率和严重程度与未监测的患者相当。
提示单独使用低剂量肝素预防经BU - CY方案预处理的allo - HSCT后VOD是有效且安全的。将肝素给药时间从 - 7天至 + 21天缩短至 - 7天至 + 14天不影响低剂量肝素预防VOD的有效性。
