Sun Yu-qian, Zhang Xiao-hui, Liu Dai-hong, Xu Lan-ping, Liu Kai-yan, Huang Xiao-jun
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2013 Aug;34(8):664-8. doi: 10.3760/cma.j.issn.0253-2727.2013.08.005.
To explore the kinetics of platelet reconstitution and its prognostic significance in patients received unmanipulated haploidentical stem cell transplantation (Haplo-HSCT) without in vitro T cell depletion.
A total of 291 patients received Haplo-HSCT without in vitro T cell depletion between January 2007 to December 2008 were retrospectively reviewed. They were categorized into 3 groups according to the platelet count on day 30, day 60 and day 90: (1) persistent thrombocytopenia (Group A) was defined as the platelet count never reached 50×10⁹/L on the three time points; (2) unstable thrombocytopenia (Group B): the platelet count recovered to a level of 50×10⁹/L by day 30 or 60 or 90, yet did not reach a level of more than 100×10⁹/L; (3) non-thrombocytopenia (Group C): the platelet count was higher than 100×10⁹/L on day 90. The kinetics of platelet reconstitution, overall survival (OS) and treatment related mortality (TRM) were compared between 3 groups.
Of the 291 consecutive patients, 288 cases engrafted successfully and 262 cases were platelet transfusion independent. The median intervals of neutrophil and platelet engraftment were 13 (9-29) days and 17 (7-180) days, respectively. The cumulative incidence of grade III-IV acute graft versus host disease (GVHD) on day 100 and chronic GVHD at 3 years were 14.7% and 56.4% respectively. OS and TRM at 3 years were 64.6% and 22.3% respectively. At the end of the follow-up, 266 cases were platelet transfusion independent: including 71 (24.4%) cases in Group A, 147 (50.5%) in Group B and 73 (25.1%) in Group C. OS in group A, B and C was 38.0%, 69.4% and 80.8% (P<0.05) respectively. TRM in Group A, B and C was 53.5%, 17.7% and 1.4% (P<0.05) respectively. Persistent thrombocytopenia was related with lower OS and higher TRM in multivariate analysis.
Persistent thrombocytopenia was common after Haplo-HSCT without in vitro T cell depletion, and patients with persistent thrombocytopenia have poor OS and higher TRM.
探讨未进行体外T细胞去除的单倍体相合造血干细胞移植（Haplo-HSCT）患者血小板重建的动力学及其预后意义。
回顾性分析2007年1月至2008年12月期间共291例行未进行体外T细胞去除的Haplo-HSCT患者。根据第30天、第60天和第90天的血小板计数将他们分为3组：（1）持续性血小板减少（A组）定义为在这三个时间点血小板计数均未达到50×10⁹/L；（2）血小板减少不稳定（B组）：血小板计数在第30天或第60天或第90天恢复至50×10⁹/L水平，但未达到100×10⁹/L以上；（3）非血小板减少（C组）：第90天血小板计数高于100×10⁹/L。比较3组间血小板重建动力学、总生存（OS）及治疗相关死亡率（TRM）。
291例连续患者中，288例成功植入，262例不再依赖血小板输注。中性粒细胞和血小板植入的中位间隔时间分别为13（9 - 29）天和17（7 - 180）天。第100天III - IV级急性移植物抗宿主病（GVHD）的累积发生率和3年慢性GVHD的累积发生率分别为14.7%和56.4%。3年OS和TRM分别为64.6%和22.3%。随访结束时，266例不再依赖血小板输注：A组71例（24.4%），B组147例（50.5%），C组73例（25.1%）。A、B、C组的OS分别为38.0%、69.4%和80.8%（P<0.05）。A、B、C组的TRM分别为53.5%、17.7%和1.4%（P<0.05）。多因素分析显示持续性血小板减少与较低的OS和较高的TRM相关。
未进行体外T细胞去除的Haplo-HSCT后持续性血小板减少常见，持续性血小板减少的患者OS较差且TRM较高。
