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  

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

作　　者：白庆咸[1] 陈协群[1] 张永清[1] 张涛[1] 朱华锋[1] 乔庆大[1] 王一苇[1] 白燕妮[1] 周伟[1] 王文清[1] 董宝侠[1] 刘玲莉[1] 

机构地区：[1]第四军医大学西京医院血液内科,西安710032

出　　处：《临床血液学杂志》2008年第1期29-31,34,共4页Journal of Clinical Hematology

摘　　要：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8d至移植后28d,采用前列腺素E脂质微球（凯时）30-40μg/d联合小剂量肝素（100U/kg·d^-1）及复方丹参30-40ml/d,发生VOD后继续上述治疗,加用去纤苷10mg/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。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 AMI.（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 ca ses 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.

关 键 词：肝静脉闭塞性疾病 前列腺素E脂质微球 异基因造血干细胞移植 

分 类 号：R575[医药卫生—消化系统]