Unité de Transplantation et de Thérapie Cellulaire (UTTC), Département d' Hématologie, Institut Paoli-Calmettes, Marseille Cedex, France.
Exp Hematol. 2010 Jan;38(1):55-60. doi: 10.1016/j.exphem.2009.10.004.
The aim of this retrospective study was to assess platelet transfusion needs and the kinetics and predictive factors for platelet recovery after reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT).
The profile of platelet recovery and transfusion needs in the first 100 days after RIC allo-SCT from a human leukocyte antigen-identical sibling donor was analyzed in a single-center series of 166 consecutive patients.
Platelet recovery (>20g/L) was observed at a median of 9 days (range, 0-99 days) after allo-SCT. One-hundred forty-five patients could be assessed for platelet recovery at day +100, of which 99 (68%) had a platelet count >99g/L. In the multivariate analysis, a lower platelet counts before the start of conditioning, and occurrence of grade III to IV acute graft-vs-host disease significantly influenced day-100 platelet recovery >100 x 10(9)/L (odds ratio [OR] = 2.51; 95% confidence interval [CI], 1.13-5.61; p = 0.025; and OR = 7.6; 95% CI, 3.0-19.29; p = 0.00002, respectively). Eighty-three patients (50%) did not require any platelet transfusion during follow-up. Multivariate analysis found the following parameters to be significantly associated with platelet transfusion needs: conditioning regimen type (use of antithymoglobulin: OR = 3.96; 95% CI, 1.77-8.89; p = 0.008), platelet count prior to RIC administration (>144g/L; OR = 0.18; 95% CI, 0.08-0.39; p = 0.00001) and occurrence of grade III to IV acute GVHD (OR = 11.62; 95% CI, 4.01-33.66; p = 0.000006).
Overall, these observations show a lower rate of platelet transfusion and faster platelet recovery kinetics after RIC HSCT, but also highlight the negative effect of severe acute GVHD as a risk factor for increased need for platelet transfusions.
本回顾性研究旨在评估在接受低强度预处理（RIC）异基因造血干细胞移植（HSCT）后的血小板输注需求以及血小板恢复的动力学和预测因素。
分析了 166 例连续接受 HLA 相同的同胞供体 RIC allo-SCT 患者在预处理后 100 天内血小板恢复和输注需求的特征。
allo-SCT 后中位 9 天（范围 0-99 天）观察到血小板恢复（>20g/L）。145 例患者可在第+100 天评估血小板恢复情况，其中 99 例（68%）血小板计数>99g/L。在多变量分析中，预处理前血小板计数较低以及出现 3 级至 4 级急性移植物抗宿主病显著影响第 100 天血小板恢复>100×10（9）/L（比值比[OR]为 2.51；95%置信区间[CI]为 1.13-5.61；p=0.025；OR=7.6；95%CI，3.0-19.29；p=0.00002）。83 例（50%）患者在随访期间无需任何血小板输注。多变量分析发现以下参数与血小板输注需求显著相关：预处理方案类型（使用抗胸腺球蛋白：OR=3.96；95%CI，1.77-8.89；p=0.008）、RIC 给药前血小板计数（>144g/L；OR=0.18；95%CI，0.08-0.39；p=0.00001）和 3 级至 4 级急性 GVHD（OR=11.62；95%CI，4.01-33.66；p=0.000006）的发生。
总体而言，这些观察结果表明 RIC HSCT 后血小板输注率较低，血小板恢复动力学更快，但也突出了严重急性 GVHD 作为增加血小板输注需求的危险因素的负面影响。
