内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (04): 283-288.doi: 10.16138/j.1673-6087.2022.04.003

• 论著 • 上一篇    下一篇

重组人血小板生成素治疗急性髓系白血病化疗后血小板减少

蒋天依, 刘福佳, 程雯艳, 赵慧瑾(), 沈杨()   

  1. 上海交通大学医学院附属瑞金医院血液科 上海血液学研究所 医学基因组学国家重点实验室,上海 200025
  • 收稿日期:2021-12-27 出版日期:2022-07-18 发布日期:2022-08-08
  • 通讯作者: 赵慧瑾,沈杨 E-mail:shen_yang@126.com;celine_zh@outlook.com

Recombinant human thrombopoietin in treatment of acute myeloid leukemia thrombocytopenia after chemotherapy: a real-world study

JIANG Tianyi, LIU Fujia, CHENG Wenyan, ZHAO Huijin(), SHEN Yang()   

  1. Department of Hemato-logy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Shanghai 200025, China
  • Received:2021-12-27 Online:2022-07-18 Published:2022-08-08
  • Contact: ZHAO Huijin,SHEN Yang E-mail:shen_yang@126.com;celine_zh@outlook.com

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摘要：

目的： 探索重组人血小板生成素（recombinant human thrombopoietin,rhTPO）用于治疗急性髓系白血病（acute myeloid leukemia,AML）化疗后血小板减少的临床疗效和安全性。方法： 纳入529例在我院接受初次诱导化疗的AML患者,根据用药方案分为治疗组（接受rhTPO治疗,共393例）与对照组（未接受rhTPO治疗,共136例）。比较2组化疗结束后血小板计数（blood platelet count,BPC）<10×109/L、<20×109/L、<30×109/L、<50×109/L的持续天数、输注的血小板数量和依赖血小板输注的天数,以及出血事件、不良反应事件发生率,并通过门诊、查阅病历或电话回访进行随访,记录其总生存期和无进展生存期。结果： rhTPO治疗组化疗后BPC<10×109/L、<20×109/L、<30×109/L的持续时间及血小板输注的数量和依赖血小板输注的天数与对照组差异无统计学意义（均P>0.05）,BPC恢复≥50×109/L所需天数显著少于对照组（P<0.05）;在初诊时BPC<50×109/L的患者中,rhTPO治疗组化疗后BPC<10×109/L的持续时间及BPC恢复≥50×109/L所需的天数显著少于对照组（P<0.05）;rhTPO治疗组早期死亡率和出血事件发生率较对照组显著降低（P<0.05）;rhTPO治疗组不良反应发生率较对照组无明显差异,未观察到严重不良反应。结论： rhTPO可以缩短AML化疗后BPC减少的持续时间,降低早期死亡率和出血事件发生率,且不良反应发生率低,耐受性良好。

关键词: 重组人血小板生成素, 急性髓系白血病, 血小板减少, 早期死亡

Abstract:

Objective To explore the clinical efficacy and safety of recombinant human thrombopoietin(rhTPO) on chemotherapy induced thrombocytopenia(CIT) in the patients with acute myeloid leukemia(AML). Methods A total of 529 AML patients who received initial induction chemotherapy in our hospital were enrolled and were classified into a treatment group (393 cases, receiving rhTPO treatment) and a control group (136 cases, not receiving rhTPO treatment) according to their therapeutic protocols. After chemotherapy, comparisons between two groups were made on the days of the blood platelet count(BPC) less than 10×109/L, 20×109/L, 30×109/L, 50×109/L, the count of infusion thrombocytes, the days of platelet transfusion and the incidence of adverse reactions. Results The days of BPC less than 10×109/L, 20×109/L, 30×109/L, the total account of platelet infusion and the days of platelet transfusion had no difference between two groups (all P>0.05). The days of BPC restored to more than 50×109/L in the treatment group were less than those in the control group significantly（P<0.05）. In the patients with BPC less than 50×109/L on the first visit, both the days of BPC less than 20×109/L and the days of BPC restored to more than 50×109/L in the treatment group after chemotherapy were less than those in the control group (P<0.05). The early mortality and the incidence of bleeding events in treatment group were significantly less than those in the control group (P<0.05). Conclusions rhTPO can be well tolerated, and it is able to reduce the duration of CIT, the early mortality, and the incidence of bleeding events in the patients with AML after chemotherapy.

Key words: Recombinant human thrombopoietin, Acute myeloid leukemia, Thrombocytopenia, Early death

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