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目的探讨预处理前输注血制品对恶性血液病患者异基因造血干细胞移植术后造血功能恢复和急性移植物抗宿主病(aGVHD)发生情况的影响。方法对23例恶性血液病患者行异基因造血干细胞移植术治疗,其中8例于预处理前3个月内有输注血制品史,15例未输。移植过程中常规行aGVHD防治,观察预处理前输注血制品对患者异基因造血干细胞移植术后造血恢复及aGVHD发生情况的影响。结果预处理前输血组中性粒细胞恢复的中位时间为11.5 d(11~16 d),血小板恢复的中位时间为12.5 d(11~16 d);预处理前未输血组中性粒细胞恢复的中位时间为13 d(11~17 d),血小板恢复的中位时间为13 d(9~35 d);两组的造血功能恢复时间差异无统计学意义(均P>0.05)。预处理前输血组有75%(6/8)的患者发生aGVHD,其中Ⅰ度3例,Ⅲ度1例,超急性(hGVHD)2例;未输血组有60%(9/15)患者发生aGVHD,其中Ⅰ度3例,Ⅱ度3例,Ⅲ度2例,Ⅳ度1例;两组aGVHD发生率差异有统计学意义(P=0.001)。发生aGVHD的患者经治疗均得到有效控制。结论恶性血液病异基因造血干细胞移植患者在移植前短期内输血对造血干细胞的植入及造血功能恢复未产生明显影响,但会增加aGVHD发生的可能性,对这部分患者应加强aGVHD的防治。
Objective To investigate the effect of preconditioned infusion blood products on hematopoietic recovery and acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation in patients with hematologic malignancies. Methods Allogeneic hematopoietic stem cell transplantation was performed in 23 patients with hematologic malignancies. Among them, 8 patients had a history of blood transfusion within 3 months before pretreatment, and 15 patients did not lose their blood transfusion. In the process of transplantation, aGVHD was routinely used to prevent and treat hemorrhage and to observe the effect of pre-treatment infusion blood products on hematopoietic recovery and aGVHD after allogeneic hematopoietic stem cell transplantation. Results The median time of neutrophil recovery before transfusion in pretreatment group was 11.5 d (11-16 days) and the median time to platelet recovery was 12.5 d (11-16 d). Neutrophil The median time to recovery of the cells was 13 days (range, 11-17 days) and the median time to platelet recovery was 13 days (9-35 days). There was no significant difference in recovery time of hematopoietic function between the two groups (all P> 0.05) . AGVHD occurred in 75% (6/8) of the pretransfusion transfusions, with 3 cases of grade I, 1 case of grade III and 2 cases of hyperacute (hGVHD); 60% (9/15) of patients without transfusion aGVHD, including 3 cases of grade Ⅰ, 3 cases of grade Ⅱ, 2 cases of grade Ⅲ and 1 case of grade Ⅳ. There was significant difference in the incidence of aGVHD between the two groups (P = 0.001). Patients with aGVHD are treated effectively. Conclusions Transfusion of hematopoietic stem cells and hematopoietic function in patients with hematologic malignancy allogeneic hematopoietic stem cell transplantation have no obvious effect on transplanted hematopoietic stem cells and hematopoietic recovery shortly before transplantation, but may increase the possibility of aGVHD, and prevention and treatment of aGVHD should be strengthened in this part of patients.