Hu Huan, Lei Dongmei, Liang Yan
General Department, Chongqing University Cancer Hospital, Shapingba District, Chongqing, 12-24-6, Caixin Shabin City, 400030, China.
World J Surg Oncol. 2025 Jan 15;23(1):13. doi: 10.1186/s12957-025-03659-8.
To observe the clinical efficacy of TPO receptor agonists and platelet transfusion in chemotherapy-induced thrombocytopenia in malignant tumors.
Clinical data from 120 patients with malignant tumors who developed thrombocytopenia following chemotherapy at our hospital were retrospectively collected and randomly divided into three groups: A, B, and C, with 40 patients in each group. Group A was treated with a TPO receptor agonist (avatrombopag), group B received autologous platelet transfusion, and group C received a combination of both treatments. The clinical efficacy of the three groups was compared, including platelet levels at different time points during treatment, platelet recovery time (time to reach < 50 × 10/L, ≥ 75-100 × 10/L, and ≥ 100 × 10/L), changes in serum cytokine levels (PF4, TPO, vWF) before and after treatment, and fluctuations in coagulation function indicators (APTT, PT, FIB) before and after treatment to analyze the effectiveness of each treatment regimen.
About clinical efficacy, the effectiveness in group A was comparable to that in group B (P > 0.05), while the effective rate in group C was significantly higher than that in groups A and B (P < 0.05). Regarding platelet counts, repeated measures analysis of variance showed significant differences in the time effect, group effect, and interaction effect for platelet counts (PLT) among the three groups (P < 0.05). Concerning platelet recovery time, the time to reach PLT < 50 × 10/L, the time to recover to 75-100 × 10/L, and the time to recover to ≥ 100 × 10/L were similar in groups A and B (P > 0.05). However, the time for these parameters in group C was significantly shorter than in groups A and B (P < 0.05). In terms of changes in platelet parameters, post-treatment levels of PF4, TPO, and vWF in all three groups were significantly higher than pre-treatment levels. The PF4, TPO, and vWF levels in groups A and B were similar (P > 0.05), whereas group C had significantly higher levels compared to groups A and B (P < 0.05). Regarding coagulation indices, post-treatment levels of APTT and PT decreased, while FIB levels increased in all three groups (P < 0.05). There were no significant differences in APTT and FIB levels between groups A and B (P > 0.05). However, group C had significantly lower APTT and higher FIB levels compared to groups A and B (P < 0.05). There were no significant differences in PT levels among the three groups post-treatment (P > 0.05).
Autologous platelet transfusion and TPO receptor agonists are effective clinical methods for treating chemotherapy-induced thrombocytopenia. The combined use of both treatments yields better therapeutic results.
观察TPO受体激动剂和血小板输注治疗恶性肿瘤化疗所致血小板减少症的临床疗效。
回顾性收集我院120例化疗后出现血小板减少症的恶性肿瘤患者的临床资料，并随机分为A、B、C三组，每组40例。A组采用TPO受体激动剂（阿伐曲泊帕）治疗，B组接受自体血小板输注，C组接受两种治疗方法联合应用。比较三组的临床疗效，包括治疗期间不同时间点的血小板水平、血小板恢复时间（达到<50×10⁹/L、≥75 - 100×10⁹/L和≥100×10⁹/L的时间）、治疗前后血清细胞因子水平（PF4、TPO、vWF）的变化以及治疗前后凝血功能指标（APTT、PT、FIB）的波动情况，以分析各治疗方案的有效性。
关于临床疗效，A组的有效性与B组相当（P>0.05），而C组的有效率显著高于A组和B组（P<0.05）。关于血小板计数，重复测量方差分析显示三组间血小板计数（PLT）的时间效应、组效应和交互效应存在显著差异（P<0.05）。关于血小板恢复时间，A组和B组达到PLT<50×10⁹/L的时间、恢复至75 - 100×10⁹/L的时间以及恢复至≥100×10⁹/L的时间相似（P>0.05）。然而，C组这些参数的时间明显短于A组和B组（P<0.05）。在血小板参数变化方面，三组治疗后PF4、TPO和vWF水平均显著高于治疗前。A组和B组的PF4、TPO和vWF水平相似（P>0.05），而C组水平显著高于A组和B组（P<0.05）。关于凝血指标，三组治疗后APTT和PT水平降低，而FIB水平升高（P<0.05）。A组和B组的APTT和FIB水平无显著差异（P>0.05）。然而，C组的APTT显著低于A组和B组，FIB水平高于A组和B组（P<0.05）。三组治疗后PT水平无显著差异（P>0.05）。
自体血小板输注和TPO受体激动剂是治疗化疗所致血小板减少症的有效临床方法。两种治疗方法联合应用可产生更好的治疗效果。
