高剂量重组人促红细胞生成素未能加速异基因骨髓移植中的血小板重建。一项初步研究的结果。

High doses of recombinant human erythropoietin fail to accelerate platelet reconstitution in allogeneic bone marrow transplantation. Results of a pilot study.

作者信息

Vannucchi A M, Bosi A, Linari S, Guidi S, Longo G, Lombardini L, Mariani M P, Saccardi R, Laszlo D, Rossi Ferrini P

机构信息

Department of Hematology, Careggi Hospital, University of Florence, Italy.

出版信息

Haematologica. 1997 Jan-Feb;82(1):53-6.

PMID:9107083

Abstract

BACKGROUND AND OBJECTIVE

The effectiveness of recombinant human erythropoietin (rhEpo) in accelerating erythroid engraftment in patients undergoing allogeneic bone marrow transplantation (BMT) has been demonstrated in previous studies. On the other hand, there are experimental data suggesting that high doses of rhEpo might also exert a stimulatory effect on thrombopoiesis.

METHODS

We carried out a pilot study on the use of high doses of rhEpo (500 U/kg/day for 30 days after transplant) in ten patients (HD-Epo group) receiving BMT to evaluate the effects on both erythroid and platelet (Plt) engrafment. This group was compared to ten BMT patients who had not received the hormone (Placebo group).

RESULTS

The HD-Epo group patients showed signs of accelerated erythropoietic recovery; in fact, the time required to reach a reticulocyte count higher than 30 x 10(9)/L was significantly shorter than in the Placebo group, while the number of high RNA content reticulocytes (HFR) was about three times greater. Circulating transferrin receptor (TfR) levels 30 days after BMT were also significantly higher in the HD-Epo group than in the other. Finally, the number of red blood cell (RBC) transfusions in the first 30 days following BMT was about twofold lower in the HD-Epo group; moreover, 4/10 patients who were treated with HD-Epo did not require any RBC units. No significant effects on the engraftment of platelets or on the number of Plt transfusions were observed in the HD-Epo as compared to the Placebo group. No adverse effect was noted on granulocytopoiesis, nor were any adverse clinical experiences found in patients who had been treated with erythropoietin at high dosages.

INTERPRETATION AND CONCLUSIONS

These data confirm that rhEpo may stimulate erythroid reconstitution after BMT, while its effects on Plt engraftment and on Plt transfusion requirements are minimal.

摘要

背景与目的

既往研究已证实重组人促红细胞生成素（rhEpo）在加速异基因骨髓移植（BMT）患者红系植入方面的有效性。另一方面，有实验数据表明高剂量rhEpo可能对血小板生成也有刺激作用。

方法

我们对10例接受BMT的患者（高剂量Epo组）使用高剂量rhEpo（移植后30天，500 U/kg/天）进行了一项初步研究，以评估其对红系和血小板（Plt）植入的影响。将该组与10例未接受该激素的BMT患者（安慰剂组）进行比较。

结果

高剂量Epo组患者显示出红系恢复加速的迹象；事实上，达到网织红细胞计数高于30×10⁹/L所需的时间明显短于安慰剂组，而高RNA含量网织红细胞（HFR）的数量约为其三倍。BMT后30天，高剂量Epo组循环转铁蛋白受体（TfR）水平也显著高于另一组。最后，BMT后前30天高剂量Epo组红细胞（RBC）输注次数约低两倍；此外，接受高剂量Epo治疗的10例患者中有4例不需要任何RBC单位。与安慰剂组相比，高剂量Epo组对血小板植入或Plt输注次数未观察到显著影响。未观察到对粒细胞生成的不良影响，高剂量促红细胞生成素治疗的患者也未发现任何不良临床情况。