Beguin Y, Oris R, Fillet G
Department of Medicine, University of Liège, CHU Sart-Tilman, Belgium.
Bone Marrow Transplant. 1993 Apr;11(4):285-92.
The mechanisms of erythrocyte recovery after BMT are not known. We investigated the respective role of marrow function and erythropoietin production in 31 ABMT and 47 allogeneic BMT by analysing peripheral counts, serum erythropoietin levels, and serum transferrin receptor (TfR) levels which have been shown to be a quantitative measurement of erythropoiesis. Median times to complete neutrophil (25 vs 48 days, p < 0.0001) and platelet (45 vs 263 days, p < 0.001) recovery were faster after allogeneic BMT than ABMT, but complete erythrocyte recovery was slower (218 vs 101 days, p < 0.001). After ABMT, erythrocyte recovery paralleled that of neutrophils and platelets, and erythropoietin levels remained appropriate for the degree of anemia. After allogeneic BMT, erythrocytes developed independently of the other cell lines and defective erythropoietin production delayed recovery of adequate erythropoietic activity. This correlated with an alteration of renal function only in those patients remaining erythropoietin deficient beyond day 180. However, supranormal erythropoietin levels in interstitial pneumonia suggests that erythropoietin response to hypoxia is not abrogated. CMV infection could also affect erythropoiesis through erythropoietin production after ABMT as well as allogeneic BMT. It is concluded that after ABMT the development of erythropoiesis is determined by the overall marrow proliferative activity and erythropoietin plays only a facilitating role. After allogeneic BMT, erythropoiesis depends on erythropoietin levels which remain inadequate for prolonged periods of time. The results suggest that the administration of recombinant human erythropoietin could reduce transfusion requirements after BMT.
骨髓移植（BMT）后红细胞恢复的机制尚不清楚。我们通过分析外周血细胞计数、血清促红细胞生成素水平和血清转铁蛋白受体（TfR）水平，研究了31例自体骨髓移植（ABMT）和47例异基因骨髓移植中骨髓功能和促红细胞生成素产生各自的作用，血清转铁蛋白受体水平已被证明是红细胞生成的定量指标。异基因骨髓移植后中性粒细胞（25天对48天，p<0.0001）和血小板（45天对263天，p<0.001）完全恢复的中位时间比自体骨髓移植更快，但红细胞完全恢复较慢（218天对101天，p<0.001）。自体骨髓移植后，红细胞恢复与中性粒细胞和血小板的恢复平行，促红细胞生成素水平与贫血程度相适应。异基因骨髓移植后，红细胞的发育独立于其他细胞系，促红细胞生成素产生缺陷延迟了足够的红细胞生成活性的恢复。这仅与180天后仍缺乏促红细胞生成素的患者的肾功能改变有关。然而，间质性肺炎中促红细胞生成素水平超常提示对缺氧的促红细胞生成素反应未被消除。巨细胞病毒（CMV）感染也可能通过自体骨髓移植以及异基因骨髓移植后促红细胞生成素的产生影响红细胞生成。得出的结论是，自体骨髓移植后红细胞生成的发育由整体骨髓增殖活性决定，促红细胞生成素仅起促进作用。异基因骨髓移植后，红细胞生成取决于长时间内仍不足的促红细胞生成素水平。结果表明，重组人促红细胞生成素的应用可减少骨髓移植后的输血需求。
