Objective: To analyze the effect of recombinant human thrombopoietin (rhTPO) on platelet (PLT) reconstitution after autologous peripheral blood stem cell transplantation (APBSCT) in patients with multiple myeloma (MM).
Methods: The clinical data of 147 MM patients who were diagnosed in the First Affiliated Hospital of Soochow University and received APBSCT as the first-line therapy were retrospectively analyzed. According to whether rhTPO was used during APBSCT, the patients were divided into rhTPO group (80 cases) and control group (67 cases). The time of PLT engraftment, blood product infusion requirements, the proportion of patients with PLT recovery to≥50×109/L and≥100×109/L at +14 days and +100 days after transplantation, and adverse reactions including the incidence of bleeding were compared between the two groups.
Results: There were no significant differences between the two groups in sex, age, M protein type, PLT count at the initial diagnosis, median duration of induction therapy before APBSCT, and number of CD34+ cells reinfused (all P >0.05). The median time of PLT engraftment in the rhTPO group was 10 (6-14) days, which was shorter than 11 (8-23) days in the control group (P < 0.001). The median PLT transfusion requirement in the rhTPO group during APBSCT was 15(0-50)U, which was less than 20 (0-80)U in the control group (P =0.001). At +14 days after transplantation, the proportions of patients with PLT≥50×109/L in the rhTPO group and the control group were 66.3% and 52.2%, while the proportions of patients with PLT≥100×109/L were 23.8% and 11.9%, respectively, with no significant differences (all P >0.05). At +100 days after transplantation, the proportion of patients with PLT≥50×109/L in rhTPO group and control group was 96.3% and 89.6%, respectively (P >0.05), but the proportion of patients with PLT≥100×109/L in rhTPO group was higher than that in control group (75.0% vs 55.2%, P =0.012). There was no difference in the overall incidence of bleeding events in different locations during period of low PLT level of patients between the two groups. In rhTPO group, the rhTPO administration was well tolerated, and the incidences of abnormal liver and kidney function and infection were similar to those in the control group.
Conclusion: When MM patients undergo first-line APBSCT, subcutaneous injection of rhTPO can shorten the time of platelet engraftment, reduce the transfusion volume of blood products, and be well tolerated, moreover, more patients have achieve a high level of PLT recovery after transplantation, which is very important for ensuring the safety of APBSCT and maintenance therapy.
题目: 重组人血小板生成素对多发性骨髓瘤患者自体外周血造血干细胞移植术后血小板重建影响的研究.
目的: 分析重组人血小板生成素（rhTPO）对多发性骨髓瘤（MM）患者自体外周血造血干细胞移植术 （APBSCT）后血小板（PLT）重建的影响。.
方法: 回顾性分析在苏州大学附属第一医院一线行APBSCT治疗的147例MM患者的临床资料，根据APBSCT期间是否使用rhTPO分为rhTPO组80例和对照组67例，比较两组患者在PLT植入时间、血制品输注需求量、移植后+14和+100 d PLT恢复至≥50×109/L和≥100×109/L的患者比例以及出血发生率等方面的差异。.
结果: 两组患者在性别、年龄、M蛋白类型、初诊时PLT数、APBSCT前诱导治疗中位疗程数、回输的CD34+细胞数方面均无统计学差异（均P >0.05）。rhTPO组患者PLT植入中位时间为10（6-14）d，较对照组11（8-23）d显著缩短（P < 0.001）。rhTPO组患者在APBSCT期间的中位PLT输注需求量为15（0-50）U，较对照组20（0-80）U更少（P =0.001）。移植后+14 d时rhTPO组和对照组PLT≥50×109/L的患者比例分别为66.3% 和52.2%，PLT≥100×109/L的患者比例分别为23.8%和11.9%，比较差异均无统计学意义（P >0.05）。在移植后+100 d时，rhTPO组和对照组PLT≥50×109/L的患者比例分别为96.3%和89.6%（P >0.05），但rhTPO组PLT≥ 100×109/L的患者比例高于对照组（75.0% vs 55.2%，P =0.012）。两组患者在PLT水平低下期间不同部位出血事件的总体发生率无差异，且rhTPO组治疗耐受性良好，肝肾功能异常和感染的发生概率与对照组类似。.
结论: MM患者在一线行APBSCT时，皮下注射rhTPO药物可以缩短PLT植入时间，减少血制品的需求量，耐受性良好，且在移植后有更多患者达到了PLT高水平的恢复，这对保证APBSCT和MM患者维持治疗期间的安全具有重要意义。.
Keywords: recombinant human thrombopoietin; multiple myeloma; autologous peripheral blood stem cell transplantation; platelet reconstitution.