前列腺素E脂质微球联合小剂量肝素及丹参预防60例异基因造血干细胞移植后肝静脉闭塞病

目的:探讨前列腺素E脂质微球联合小剂量肝素及复方丹参预防肝静脉闭塞病(VOD)的效果.方法:59例急、慢性白血病患者及1例T细胞淋巴瘤患者接受移植治疗.移植患者中3例曾有乙型肝炎病史,1例有轻度脂肪肝病史.移植前所有患者肝功能均正常.采用CyTBI加Ara-C/VP-16或改良BuCy2方案预处理.VOD预防方案:移植前8 d至移植后28 d,采用前列腺素E脂质微球(凯时)30～40vg/d联合小剂量肝素(100U/kg·d-1)及复方丹参30～40 ml/d,发生VOD后继续上述治疗,加用去纤苷10 mg/kg·d-1.结果:59例均获得植入,1例植入失败.2例出现重症VOD,其中1例为接受单倍型半相合外周血干细胞移植的复发ALL患者,1例患者有轻度脂肪肝,接受非血缘外周血干细胞移植.2例均采用较强的清髓性预处理方案,最终死于多脏器功能衰竭.结论:本研究采用的VOD预防方案,VOD发生率低于文献报道,提示前列腺素E脂质微球联合小剂量肝素及复方丹参方案对预防VOD的发生可能有一定效果.

Efficacy of VOD Prophylaxis with Lipo-prostaglandin E1,Low-dose Unfractionated Heparin and Danshen in Allogeneic Heamatopoietic Stem Cell Transplantation for 60 Patients with Hematologic Malignancy

Objective:Veno-occlusive disease(VOD)of liver is well recognized as one of the most common and severe regimen-related toxicities occurring after hematopoietic stem cell transplantation.We explore the efficacy of VOD prophylaxis with lipo-prostaglandin E1,low-dose unfractionated heparin and Dansen in allogeneic heamatopoietic stem cell transplantation(HSCT)for 60 patients with hematologic malignancy.Method:59 leukemia patients including 14 cases ALL(CR1 =6,CR2 =3,relapse=5),19 cases AML(CR1 =14,Relapse=5)and 26 cases CML(CP =21,BC =5)and 1 patient with T cell lymphoma received allogeneic peripheral blood stem cell transplantation(PBSCT)or bone marrow transplantation(BMT)from HLA-identical sibling(n=44)and 1-locus mismatched(n=2)and 3-locus mismatched sibling(n=7),6 patients received BMT or PBSCT from identical unrelated donor,1 patient underwent 1-locus HLA-mismatched unrelated cord blood transplantation(CBT).3 cases of recipients had suffered from hepatitis virus B.1 case with fatty liver.Conditioning for HSCT consisted of cyclophosphamide and total body irradiation plus Ara-c/VP-16 or busulphan-cyclophosphamide.VOD prophylaxis was the prostaglandin E1,low-dose unfractionated heparin and compound Dangseng.Result:59 patients got engraftment,1 patients suffered from graft failure.58/60 patients had no VOD,especially in patients with hepatitis virus B.2/60 patients developed severe VOD within 20 days of transplantation(early-onset)and after day 20(late-onset).One of them received haplo-identical PBSCT.Another had unrelated PBSCT.Two patients received more intensive cytoreductive programs and died from multiorgan function failure.Conclusion:The incidence of VOD was lower than literature reported.It is likely suggested that VOD prophylaxis with prostaglandin E1,low-dose unfractioated heparin and Dansen is efficacy in reducing the incidence of VOD.