Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 x 10(9) or 20 x 10(9) per L

BACKGROUND: A trigger of 10 x 10(9) per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 x 10(9) per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 x 10(9) and 20 x 10(9) per L prophylactic triggers. STUDY DESIGN AND METHODS: A total of 170 patients who received prophylactic PLT transfusions at 20 x 10(9) per L (1997-1998, SP1) and 211 patients who had prophylaxis at 10 x 10(9) per L (1999-2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT. RESULTS: PLT counts less than or equal to 10 x 10(9) per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts 相似文献   

A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 10(9) per L versus 30 x 10(9) per L in allogeneic hematopoietic progenitor cell transplant recipients

BACKGROUND: The impact of lowering the platelet (PLT) count threshold for prophylactic PLT transfusion on bleeding and PLT use in allogeneic hematopoietic progenitor cell (HPC) transplant recipients is a matter of debate. STUDY DESIGN AND METHODS: In 166 patients, randomly assigned to receive prophylactic PLT transfusion at a trigger level less than 10 x 10(9) PLTs per L (T10; n = 79) or less than 30 x 10(9) per L (T30; n = 87), the number of PLT and red blood cell (RBC) transfusions given and the number of hemorrhagic events (WHO Grades 2-4) were recorded. RESULTS: No significant differences were found between the two groups regarding the clinical outcome variables (i.e., bacteremia, engraftment, graft-vs.-host disease [GVHD], hospital stay, death, and survival) or in the median total number of RBC transfusions given. The incidence, in Group T10 18 percent (14/79) and in Group T30 15 percent (13/87), as well as the type of bleeding were comparable. No deaths were attributed to hemorrhages. The number of PLT units transfused, however, was significantly lower in Group T10 (median, 4; range, 0-32), than in Group T30 (median, 10; range, 0-48; p < 0.001). Apart from the trigger level, the day of engraftment, the presence of acute GVHD, or bacteremia also affected the number of PLT transfusions. CONCLUSION: A prophylactic PLT transfusion trigger level of less than 10 x 10(9) PLTs per L instead of less than 30 x 10(9) PLTs per L in allogeneic HPC transplant recipients was found to be safe and resulted in a decreased use of PLTs.     

Acute phase after haematopoietic stem cell transplantation: bleeding and thrombotic complications

The transplantation of allogeneic or autologous haematopoietic stem cells is an established treatment for many malignant and non-malignant diseases of the bone marrow. Intensive cytoreductive regimens administered before transplantation induce prolonged and severe cytopenia of all haematopoietic lineages. Thrombocytopenia leads to an increased risk of bleeding, which may be further aggravated by consumption of plasmatic factors as a result of tumour lysis or after antibody administration. At the same time, patients after transplantation are also at increased risk of thrombotic complications. Endothelial damage induced by radio- and chemotherapy, indwelling catheters, prolonged immobilization and a high incidence of systemic infection all contribute to the frequent occurrence of thromboembolic events in this population. This review discusses the incidence and risk factors for haemorrhagic and thrombotic complications after stem cell transplantation. Special emphasis is given to complications occurring specifically in the context of transplantation such as diffuse alveolar haemorrhage, haemorrhagic cystitis, veno-occlusive disease, and transplant associated microangiopathy.     

The investigation of platelet transfusion refractory in 69 malignant patients undergoing hematopoietic stem cell transplantation

Background

Platelet transfusion refractoriness (PTR) is thought to be associated with HPA and HLA incompatibility but be unrelated to ABO incompatibility in practice. In this study we aim to investigate the incidence of PTR and potential risks in patients undergoing hematopoietic stem cell transplantation (HSCT).

Method

A total of 69 HSCT patients were involved with their basic characteristics recorded. PTR was identified by 24 h corrected count increment (24 h-CCI) post platelet transfusion and we transformed it to the corrected platelet increment (CPI), which was compared between the PTR and non PTR groups. Age, gender, ABO incompatibility, disease and CPI were analyzed by Logistic regression analysis for PTR incidence. We searched our medical records to find possible risks of PTR with different levels of CPI.

Results

There was no significant difference of platelet engraftment (PE) (P = 0.271) and platelet requirement (PR) (P = 0.333) between patients with ABO matched and mismatched transplants. Thirteen patients experienced PTR but with a varied refractory ratio (20–95%). Logistic regression analysis showed that the CPI <10 × 10⁹/l (P = 0.006) was dramatically related to the PTR while ABO incompatibility (P = 0.319), MDS (P = 0.552), PLT count pre-transplantation <50 × 10⁹/l (P = 0.998) were of no statistical significance. There were 142 U (32.7%) of platelets transfused with unsatisfactory CPIs, mainly (48.6%) within the second week since transplantation. From the investigation of medical records, infections, fever and bleeding were the most common reasons for PTR.

Conclusions

PTR is a common phenomenon but more associated with non-immune causes in HSCT. The quantification of CPI may imply potential risks of PTR and help clinicians to better use platelet apheresis.     

血小板相关参数在造血干细胞移植后巨核系重建中的应用

目的探讨血小板相关参数以了解造血干细胞移植（HSCT）在巨核系重建中的意义。方法对28例HSCT患者的巨核系重建情况与血小板相关参数进行回顾性分析。结果28例移植患者在移植后15d内骨髓处于空虚期，骨髓穿刺涂片及活检显示均未发现巨核细胞，血小板计数与移植前比较下降明显（P〈0．05）；HSCT后恢复期患者巨核系成功重建且骨髓造血功能恢复22例（22／28），骨髓穿刺涂片及活检显示巨核细胞均超过5个／片，恢复的时间平均为63．7d，巨核细胞分类以颗粒型巨核细胞为主，巨核细胞数量与BPC无明显相关（r=0．364，P〉0．1）。经多因素方差分析及t检验，恢复期BPC较空虚期明显增高，且差异存在统计学意义（P〈0．05）；空虚期、血小板输注后及恢复期的MPV之间差异无统计学意义（P〉0．05）；恢复期PDW较空虚期、血小板输注后增高，差异存在统计学意义（P〈0．05），且PDW增高早于BPC增高出现。结论HSCT后，血小板及其相关参数中，PDW变化最早且增高明显，这为停止输注血小板和骨髓穿刺证实HSCT后巨核系重建是否成功提供了一个早期的重要的实验搴判断指标。     

Recombinant activated factor VII in treatment of bleeding complications following hematopoietic stem cell transplantation

BACKGROUND: Bleeding is a common complication following hematopoietic stem cell transplantation (HSCT) and standard hemostatic treatment is often ineffective. We conducted a multicentre, randomized trial of the efficacy and safety of activated recombinant factor VII (rFVIIa, NovoSeven) in the treatment of bleeding following HSCT. METHODS: 100 patients with moderate or severe bleeding (52 gastrointestinal; 26 hemorrhagic cystitis; seven pulmonary; one cerebral; 14 other) were included from days +2 to +180 post-transplant (97 allogeneic; three autologous) to receive seven doses of rFVIIa (40, 80 or 160 microg kg(-1)) or placebo every 6 h. The primary efficacy endpoint was the change in bleeding score between the first administration and 38 h. RESULTS: No significant effect of increasing rFVIIa dose was observed on the primary endpoint. A post hoc analysis comparing each rFVIIa dose with placebo showed that 80 microg kg(-1) rFVIIa improved the bleeding score at the 38 h time point (81% vs. 57%, P = 0.021). This effect was not seen at 160 microg kg(-1). There were no differences in transfusion requirements across dose groups. There was no trend in the type or number of severe adverse events observed. Six thromboembolic events were observed in the active treatment groups: three during, and three following the 96-h observation period. CONCLUSIONS: Despite no overall effect of rFVIIa treatment on primary endpoint, post hoc analysis showed an improvement in the control of bleeding for 80 microg kg(-1) rFVIIa vs. standard hemostatic treatment. The heterogeneity of the population may have contributed to the lack of an increasing effect with increased dose. Further trials should focus upon identifying the patient populations that may benefit from treatment with rFVIIa.     

Factors associated with the avoidance of red blood cell transfusion after hematopoietic stem cell transplantation

BACKGROUND: Red blood cell (RBC) transfusion is required frequently for most patients after hematopoietic stem cell transplantation (HSCT). RBC transfusion, however, can be associated with adverse events including transfusion reactions, acquiring transmissible disease, and delayed recovery. Factors associated with avoidance of transfusion are not well documented. STUDY DESIGN AND METHODS: Data concerning RBC transfusions between Day 0 and Day +30 were analyzed for patients undergoing HSCT at a single Canadian transplant center between January 2002 and December 2007. RESULTS: Of 555 patients undergoing HSCT with complete RBC transfusion data, 59 patients (10.6%) did not require RBC transfusion in the first 30 days after HSCT. Univariate analysis showed no significant difference in age, graft source, donor type, or conditioning regimen between transfused and nontransfused patients. Factors that were significantly associated with avoidance of transfusion included male sex (p = 0.0013), diagnosis, specifically plasma cell dyscrasias (p < 0.0001), early‐stage disease (p = 0.006), and higher baseline hemoglobin (Hb) at time of transplant (p < 0.0001). In multivariate analysis, higher pretransplant Hb, male sex, and early‐stage disease remained significantly associated with avoidance of RBC transfusion. Pretransplant Hb correlated inversely with the number of RBC transfusions (r = ?0.89). CONCLUSION: Increased pretransplant Hb, male sex, and early‐stage disease are associated with avoidance of RBC transfusion after HSCT. Interventions aimed at improving pretransplant Hb levels require further study.     

inv(9)血液病患者造血干细胞移植后骨髓造血恢复特征研究

目的探讨9号染色体倒位[inv(9)]患者在接受造血干细胞移植后中性粒细胞计数(ANC)和血小板计数(PLT)等骨髓造血恢复特征。方法选取2010年1月至2015年10月本院确诊的39 589例血液病患者作为研究对象,采用R显带技术、聚合酶链反应(PCR)技术和流式细胞仪检测技术进行染色体核型检查、融合基因检测和骨髓造血恢复相关指标检测。结果 inv(9)血液病患者检出PML-RARα、BCR-ABL1、AML-ETO、EVI1、CBFβ-MYH11、MLL-AF6、AML-AF4、SET-NUM214、SILTALI、IgH重排、TCR重排和BCL1-IgH等多种融合基因。inv(9)患者在接受造血干细胞移植后恢复情况:ANC在移植后12d恢复至大于0.5×10~9/L水平,PLT在移植后16d恢复至大于20×10~9/L水平。非inv(9)患者在接受造血干细胞移植后恢复情况:ANC在移植后12d恢复至大于0.5×10~9/L水平,PLT在移植后13d恢复至大于20×10~9/L水平。结论 inv(9)血液病患者和非inv(9)血液病患者造血干细胞移植后ANC恢复至大于0.5×10~9/L水平所需的时间几乎相等,而inv(9)血液病患者PLT恢复所需的时间比非inv(9)血液病患者所需时间稍长。     

自体外周血干细胞移植治疗原发性淀粉样变性并发症的护理

总结11例原发性淀粉样变性患者行自体外周血干细胞移植治疗术后并发症的护理,针对术后出现的胃肠道反应、口腔黏膜炎、出血、心律失常等各种并发症,采取及时有效的病情观察和护理措施,取得了显著效果.10例患者痊愈出院,随访效果良好,1例死亡.     

血小板生成素在异基因造血干细胞移植后促进血小板植入的临床研究

目的 观察血小板生成素(TPO)在恶性血液病患者异基因造血干细胞移植(allo-HSCT)后促进血小板恢复治疗中的临床反应和安全性.方法 采用多中心、开放、随机、对照的临床研究,共120例allo-HSCT后的患者根据入组标准进入研究,按患者人组时间的先后顺序随机分为4组,对照组(A组):不用TP0;试验组:用TPO,剂量为300 U·kg-1·d-1,根据不同的用药时机[分别为移植后1天(+1)、+4、+7 d开始],分为B、C、D 3组.最终可评估的患者共89例,其中A组22例,B组23例,C组20例,D组24例.观察有效性评价指标(血小板恢复时间、血小板输注次数)和安全性评价指标[不良事件、血常规、肝肾功能、凝血功能和移植物抗宿主病(GVHD)的发生].结果 试验组B、C、D 3组的血小板植入时间分别为(13.17±2.89)、(12.15±2.08)和(12.33±1.76)d;对照组为(14.82±5.05)d,差异有统计学意义(P=0.029).试验组3组间在血小板恢复时间、血小板最低值及输血量方面差异无统计学意义.试验组未见明显不良反应.结论 TPO应用于恶性血液病患者allo-HSCT后可以缩短血小板恢复时间,于+7d开始应用是有效和安全的.     

重视儿童造血干细胞移植(HSCT)术后并发症影像学表现

造血干细胞移植(HSCT)在治疗各种儿科难治性良性疾病和恶性肿瘤中具有越来越重要的作用,而诊断和干预HSCT术后并发症影响疗效和预后.目前针对HSCT术后并发症虽已取得可喜成果,但仍面临着不能尽早准确诊断并及时治疗的困境.医学影像学的发展为此提供了助力.HSCT术后常见中枢神经系统感染和可逆性后循环脑病、肺部感染、累及...     

重视造血干细胞移植合并症的诊治

造血干细胞移植(HSCT)是多种血液系统恶性疾病的有效治疗手段.虽然近年来血液系统恶性疾病新治疗手段如诱导分化、靶向治疗等取得重要进展,使HSCT在急性早幼粒细胞白血病、慢性粒细胞白血病治疗中的地位有所下降;但是另一方面,由于非血缘供者移植、脐血移植及单倍型HSCT的完善及推广,拓宽了供者来源范围.     

异基因造血干细胞移植治疗白血病例

重庆医科大学附属第一医院血液内科2007-01/2008-04应用异基因造血干细胞移植治疗白血病患者9例,6例急性髓细胞性白血病,3例慢性髓系自血病;供者中6例为HLA完全相合的同胞,2例为HLA 9/10相合的无关供者,1例为半相合供者:预处理采用经典的BU/CY方案或GIAC方案;移植物抗宿主病的预防采用环孢菌素A+吗替麦考酚酯+甲氨喋呤方案或环孢菌素A+吗替麦考酚酯+甲氨喋呤+抗胸腺细胞球蛋白方案.结果全部患者均获得造血重建,中性粒细胞≥0.5×109 L-1,血小板＞20×109-1的中位时间分别是11,15 d;无急性移植物抗宿主病发生,1例发生慢性移植物抗宿主病;随访3～16个月无病生存率为77.8%.死亡2例.     

重组人血小板生成素对外周血造血干细胞移植后患者血小板重建的影响

目的观察外周血干细胞移植(PBHSCT)后d3使用重组人血小板生成素(rHuTPO)对移植后患者血小板重建的影响及其不良反应。方法根据PBHSCT后d3是否使用rHuTPO的情况,将2011年在本科接受PBHSCT的40名患者分为rHuTPO治疗组(n=20)和对照组(n=20),回顾性分析、比较2组中接受3种不同移植物来源(自体造血干细胞、HLA异基因相合造血干细胞和HLA单体型相合异基因造血干细胞)的患者移植后血小板重建、输注血小板次数等相关指标。结果 HLA自体造血干细胞移植病例中,rHuTPO治疗组(n=4)和对照组(n=6)患者移植后Plt升至20×109/L的时间分别为(19.33±4.03)d,(23.75±8.78)d,血小板输注次数中位数分别为5.5次、11.5次(P0.05)。HLA异基因全相合造血干细胞移植病例中,rHuTPO治疗组(n=8)和对照组(n=10)患者移植后Plt升至20×109/L的时间分别为(14.50±4.22)d,(16.13±6.58)d,血小板输注次数中位数分别为3.0次、4.0次(P0.05)。在HLA单体型相合造血干细胞移植病例中,rHuTPO治疗组(n=8)和对照组(n=4)患者移植后Plt升至20×109/L的时间分别为(16.50±7.14)d、(23.63±5.50)d(P0.05),Plt升至50×109/L的时间分别为(20.25±7.23)d、(31.75±5.23)d(P0.05),血小板输注次数中位数分别为3.0次、12.5次(P0.05)。结论 HLA异基因单体型相合相合造血干细胞移植后d3应用rHuTPO有助于移植患者血小板较快生成并减少血小板输注次数。