Gordon B, Haire W, Ruby E, Kotulak G, Stephens L, Kessinger A, Armitage J
Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-2168, USA.
Bone Marrow Transplant. 1997 Mar;19(5):497-501. doi: 10.1038/sj.bmt.1700684.
Circulating anticoagulants protein C (PC) and antithrombin III (AT) are markers of, and possibly involved in the pathogenesis of, significant organ dysfunction, in patients undergoing autologous peripheral blood stem cell (PSBC) or autologous bone marrow (BM) transplantation. The effect of the stem cell source, the use of hematopoietic growth factors (GFs), and the specific preparative regimen on the incidence of organ system dysfunction or on post-transplant levels of circulating anticoagulants has not been well studied. We analyzed 205 patients in an attempt to correlate organ dysfunction and AT and PC deficiencies with these transplant-specific factors (78 BMT with GM-CSF after transplant, 95 PBSCT without GM-CSF after transplant, and 32 PBSCT with GM-CSF after transplant). Patients transplanted with PBSC had a lower incidence of pulmonary dysfunction (20 vs 40%, P = 0.006) and liver dysfunction (4 vs 13%, P = 0.05) than patients receiving BM. The use of GF after transplant did not influence the development of subsequent organ dysfunction. In multivariate analysis, the stem cell source was again predictive of pulmonary dysfunction. In contrast, although patients transplanted with PBSC also had a lower incidence of PC deficiency (50 vs 81%, P < 0.01) and AT deficiency (20 vs 54%, P < 0.01) as compared with patients receiving BM, use of GM-CSF after transplant was a more significant risk factor for the development of anticoagulant deficiency (PBSC with GF vs PBSC without GF: PC deficiency 50 vs 78%, P = 0.007; AT deficiency 20 vs 47%, P = 0.005). In the multivariate analysis GM-CSF use was the only significant risk factor for development of anticoagulant deficiency. Since the clinical significance of anticoagulant deficiency has been well shown, further studies examining these effects of hematopoietic GFs appear warranted.
循环抗凝蛋白C（PC）和抗凝血酶III（AT）是接受自体外周血干细胞（PSBC）或自体骨髓（BM）移植患者发生重要器官功能障碍的标志物，且可能参与其发病机制。干细胞来源、造血生长因子（GFs）的使用以及特定预处理方案对器官系统功能障碍发生率或移植后循环抗凝剂水平的影响尚未得到充分研究。我们分析了205例患者，试图将器官功能障碍以及AT和PC缺乏与这些移植特异性因素相关联（78例移植后使用GM-CSF的BMT，95例移植后未使用GM-CSF的PBSCT，以及32例移植后使用GM-CSF的PBSCT）。与接受BM移植的患者相比，接受PBSC移植的患者发生肺功能障碍（20%对40%，P = 0.006）和肝功能障碍（4%对13%，P = 0.05）的发生率更低。移植后使用GF并未影响随后器官功能障碍的发生。在多变量分析中，干细胞来源再次可预测肺功能障碍。相比之下，虽然与接受BM移植的患者相比，接受PBSC移植的患者发生PC缺乏（50%对81%，P < 0.01）和AT缺乏（20%对54%，P < 0.01）的发生率也更低，但移植后使用GM-CSF是发生抗凝剂缺乏的更重要危险因素（使用GF的PBSC与未使用GF的PBSC相比：PC缺乏50%对78%，P = 0.007；AT缺乏20%对47%，P = 0.005）。在多变量分析中，使用GM-CSF是发生抗凝剂缺乏的唯一重要危险因素。由于抗凝剂缺乏的临床意义已得到充分证实，因此有必要进一步研究造血GFs的这些影响。
