目的 观察聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)与重组人粒细胞刺激因子(rhG-CSF)在造血干细胞移植后促进造血恢复的疗效对比。方法 回顾分析2016年1月—2020年12月以来在深圳市第二人民医院血液科进行造血干细胞移植的恶性血液疾病患者共 100例,随机分为2组,分别在造血干细胞回输后给与聚乙二醇化重组人粒细胞刺激因子与重组人粒细胞刺激因子。结果 PEG-rhG-CSF组与rhG-CSF组中性粒细胞植入时间分别为(18.7±3.4)天、(18.0±3.1)天,P=0.281,无统计学差异。粒细胞缺乏伴发热在PEG-rhG-CSF组与rhG-CSF组分别发生26例、29例,发生率分别为53.06%、56.86%,P=0.89,无差异。用药次数分别为2.6次(2~5次)、18.1次(11~31次),P<0.05,差异有统计学意义。不良反应主要为骨痛、肌肉疼痛。结论 PEG-rhG-CSF组与rhG-CSF组结果相似,PEG-rhG-CSF具有用药次数少的优势。

Objective The efficacy of pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) and recombinant human granulocyte stimulating factor(rhG-CSF) in promoting hematopoiesis recovery after hematopoietic stem cell transplantation.Methods The data of 100 patients with malignant blood diseases who underwent hematopoietic stem cell transplantation in the Hematology Department of Shenzhen Second People's Hospital from January 2016 to December 2020 were retrospectively analyzed.They were randomly assigned to two groups,which accepted PEG-rhG-CSF and rhG-CSF respectively after hematopoietic stem cell transfusion.Results The time of neutrophil implantation in PEG-rhG-CSF group and rhG-CSF group were (18.7±3.4) days and (18.0±3.1) days respectively,P=0.281,showing no statistical difference.There were 26 cases of neutropenia with fever in PEG-rhG-CSF group and 29 cases in rhG-CSF group,with incidence of 53.06% and 56.86% (P=0.89),showing no statistical difference.The times of medication were 2.6 times (2-5 times) and 18.1 times (11-31 times),P<0.05,with significant statistical difference.The main adverse reactions were bone pain and muscle pain.Conclusions The outcomes of PEG-rhG-CSF group and rhG-CSF group were similar,PEG-rhG-CSF had the advantage of fewer times of medication.

目的 观察利妥昔单抗在治疗造血干细胞移植后血小板输注无效的有效性和安全性。方法 回顾分析我院2014年1月—2017年6月收治的11例利妥昔单抗治疗的造血干细胞移植后血小板输注无效的病例资料,其中包括重型地中海贫血8例,急性髓系白血病1例,重型再生障碍性贫血2例。结果 10例造血干细胞移植后血小板输注无效患者经利妥昔单抗治疗,375 mg/m²,每周1次,2~3次后血小板输注无效的状况明显改善;1例造血干细胞移植后血小板输注无效患者接受1次利妥昔单抗治疗,仍存在血小板输注无效,最终因颅内出血死亡。结论 利妥昔单抗是治疗造血干细胞移植后血小板输注无效的一种很有效的治疗方法。

Objective The purpose of our study was to evaluate the efficacy and safety of rituximab in the treatment of platelet transfusion refractoriness after hematopoietic stem cell transplantation. Methods We retrospectively analyzed 11paitents （8 thalassemia major,2 sever aplastic anemia,and 1 acute myeloid leukemia） with platelet transfusion refractoriness after hematopoietic stem cell transplantation. All 11 patients received treatment of rituximab. Results 10 of 11 platelet transfusion refractoriness patients after hematopoietic stem cell transplantation had improvement of platelets transfusion,1 patient of 11 platelet transfusion refractoriness patients had no response and died of intracranial hemorrhage. Conclusion Rituximab is a promising treatment in patients with platelet transfusion refractoriness after hematopoietic stem cell transplantation.

目的 探讨单倍体亲缘异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的可行性。方法 对1例诊断SAA 4年余,先后经CsA治疗、脐血移植治疗均无效并反复输注红细胞、血小板的12岁男性患者进行单倍体亲缘异基因造血干细胞移植,供者为其胞兄,高分辨HLA基因型5/10相合,预处理方案为BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d。干细胞来源为G-CSF动员的骨髓+外周造血干细胞,共计输注单个核细胞(MNC)4.055×10⁸/kg(受者体重),CD 34 2.331×10⁶/kg。GVHD预防:-1 d采用与受者HLA部分相合的第三方脐带血细胞,术后联合应用环孢素A、短程氨甲碟呤、霉酚酸酯。结果 造血缓慢重建,术后22天(+22 d)ANC>0.5×10⁹/L,术后3月血小板脱离输注。+26天DNA指纹图全部表现为供者基因型。+40天血型转为供者型“O”型。+29 d出现急性移植物抗宿主病aGVHD(胃肠型,Ⅲ度),+31 d、+34 d及+42 d予巴利昔单抗20 mg静滴,+40 d、+44 d、+63 d输注间充质干细胞,患者急性GVHD逐渐控制。期间曾出现肺部感染、口腔黏膜炎及巨细胞病毒血症,经抗感染后可控制。现随访3年,血象正常稳定,Kamofsky评分100分。结论 单倍体亲缘异基因造血干细胞移植治疗SAA,对无相合供者(包括亲缘或非亲缘)且强效免疫抑制治疗失败的患者,可考虑进行,GVHD和感染为主要并发症,需根据患者病情采用相应措施。

Objective To investigate the feasibility of haploid genetic allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia(SAA) in our hospital. Methods A 12-year-old patient with acquired SAA for 4 years showed no response to CsA and cord blood transplant treatment and was transfusion-dependent. Lacking an HLA-identical sibling donor, the patient was treated with HSCT from his brother 5/10 matched at the generic level. Theconditioning regimen was BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d. Stem cells were the source of G-CSF mobilization of bone marrow and peripheral blood stem cells, dose of stem cells infused: mononuclear cells (MNC) 4.055×10⁸/kg (body weight of subject), CD34 2.331×10⁶/kg. Prevention of GVHD: -1 d Third-party umbilical cord blood cells which were HLA partially matched were used. Postoperative joint use included cyclosporine A, short-course methotrexate, mycophenolate mofetil. Results Hematopoiesis was slowly rebuilding, 22 d after surgery (+22 d) ANC> 0.5×10⁹/L, after three months departing from transfusion of platelets. +26 d suggesting that the DNA fingerprints showed donor genotypes. +40 d into donor blood type “O” type. + 29 d occurred acute GVHD (GI type, Ⅲ degrees), + 31 d, + 34 d + 42 d infusion of basiliximab 20mg, + 40 d, + 44 d, + 63 d infusion of mesenchymal stem cells. Gradually acute GVHD was controlled in the patient, who had lung infections, oral mucositis and cytomegalovirus viremia, could be controlled with anti-infective. Now followed up for 3 years, hemogram change has been normal and stable. Kamofsky score was 100 points. Conclusion It may be considered to have haploid genetic allogeneic hematopoietic stem cell transplantation for treatment of SAA, for those patients who have non-matched donor (including relatives and non-relatives) and potent immunosuppressive therapy failure. GVHD and infection are major complications. Need to adopt appropriate measures in accordance with the patient's condition.