Bishop J F
Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia.
Stem Cells. 1994 Jul;12(4):370-7. doi: 10.1002/stem.5530120403.
Severe thrombocytopenia and clinical bleeding remain major clinical problems in leukemic patients undergoing remission induction and those receiving high dose chemotherapy. Prophylactic platelet transfusions have made a major impact on hemorrhagic deaths over the last 20 years. The effectiveness of platelet transfusions is influenced by a number of clinical factors including the status of the spleen, prior bone marrow transplantation, the presence of disseminated intravascular coagulation and the presence of HLA antibodies. Optimal platelet transfusion therapy requires that transfusions be monitored routinely by post-transfusion counts and that a refractory group be clearly defined. The cytokine granulocyte colony stimulating factor (G-CSF) has not had a clinically significant impact on thrombocytopenia. Granulocyte-macrophage colony stimulating factor (GM-CSF) also probably has little clinical relevance, although in a randomized study, thrombocytopenia was worse in GM-CSF-treated patients. Interleukin-3 (IL-3) can increase platelet count and has the potential to protect against thrombocytopenia in patients receiving chemotherapy. This hypothesis is currently being tested in on-going clinical trials.
严重血小板减少症和临床出血仍然是白血病患者在缓解诱导期以及接受大剂量化疗患者面临的主要临床问题。在过去20年中，预防性血小板输注对出血性死亡产生了重大影响。血小板输注的有效性受到多种临床因素的影响，包括脾脏状态、既往骨髓移植情况、弥散性血管内凝血的存在以及HLA抗体的存在。最佳血小板输注治疗要求通过输血后计数常规监测输血情况，并明确界定难治性群体。细胞因子粒细胞集落刺激因子（G-CSF）对血小板减少症没有产生临床上显著的影响。粒细胞-巨噬细胞集落刺激因子（GM-CSF）可能也几乎没有临床相关性，尽管在一项随机研究中，接受GM-CSF治疗的患者血小板减少症更为严重。白细胞介素-3（IL-3）可增加血小板计数，并有可能预防接受化疗患者的血小板减少症。这一假设目前正在正在进行的临床试验中进行检验。
