含与不含抗胸腺细胞球蛋白的两种预处理方案早期毒性的比较

目的 比较采用改良白消安/环磷酰胺(Bu/Cy)方案及改良Bu/Cy+抗胸腺细胞球蛋白(ATG)方案进行预处理的异基因造血干细胞移植(HSCT)患者在预处理期间及移植后早期发生的相关毒性.方法 100例血液系统恶性肿瘤患者中,应用改良Bu/Cy方案者(A组)42例,应用改良Bu/Cy+ATG方案者(B组)58例,主要观察预处理期间及移植后早期出现的非感染性发热、腹泻、肝毒性、黏膜炎及血液系统毒性.结果 A、B两组发热发生率分别为4.8%和81.0%,转氨酶升高发生率分别为59.5%和65.5%,胆红素升高发生率分别为16.7%和48.3%,腹泻发生率分别为59.5%和79.3%,黏膜炎发生率分别为45.2%和37.9%.白细胞进入零期的中位时间分别为+3 d和-3 d;-10 d内需输注红细胞及血小板的比例分别为11.9%和32.8%,16.7%和82.8%.结论 含ATG的预处理方案组发热,腹泻,肝损害,白细胞、红细胞和血小板降低的发生率明显高于不含ATG的预处理方案组,这种改变很可能与ATG相关.

A comparative study on early toxicity of conditioning regimen with or without antithymocyte globulin

Objective To evaluate the toxicity of conditioning regimens of modified Bu/Cy +/-antithymocyte(ATG) in early stage after allogeneic hematopoietic stem cell transplantation (alIo-HSCT).Methods A hundred patients with hematological malignancies undergoing allo-HSCT were assessed.Fortytwo patients (group A) were conditioned with modified Bu/Cy regimen,58 (group B) with modified Bu/Cy + ATG regimen.The occurrence of toxicity during the early stage after transplantation was evaluated and compared,including non-infectious fever,diarrhea,hepatotoxicity,mucositis and hematological toxicity.Results In group A and B,the incidence of non-infectious fever was 4.8% vs 81.0%,transaminase elevation 59.5% vs 65.5%,bilirubin elevation 16.7% vs 48.3%,diarrhea 59.5% vs 79.3% and mucositis 45.2% vs 37.9%,respectively,white blood cells reached zero occurred at a median of +3 d and-3 d,the rate of red cell and platelet transfusion-dependence,within 10 days before transplantation was 11.9% vs 32.8 and 16.7% vs 82.8%,respectively.Conclusions Significant higher incidence of non-infectious fever,diarrhea,hepatotoxicity,leucocytopenia,and transfusion dependence is found and considered to be related to the administration of ATG in the conditioning regimen.