CAJ | 학술논문

目的探讨白血病患者异基因造血干细胞移植(Allo-HSCT)术后原因不明的血小板(PLT)下降与白血病复发之间的关系.方法 51例白血病患者于2006年4月至2009年10月在我科接受了Allo-HSCT术,其中5例患者在术后2年内出现了复发,我们回顾性分析了其复发前外周血PLT计数、骨髓形态学及植入状态的动态变化.结果 5例移植后复发患者移植早期中性粒细胞和PLT造血重建平均时间分别为15.8、25.8 d.当PLT计数降至50×109/L左右时,骨髓巨核细胞进一步减少,骨髓幼稚细胞比率虽较PLT开始下降时有所增多,但均未达到复发的标准,STR检查所有患者从FDC转变为进展性混合型嵌合体(PMC);5例患者在此后的3个月内先后发生形态学复发,复发时骨髓巨核细胞几乎消失,STR检查除1例患者仍为PMC外,其余4例患者均转变为植入失败;统计学分析发现Allo-HSCT术后PLT进行性下降可较出现PMC提前平均75 d、形态学复发提前平均164 d.结论白血病患者Allo-HSCT术后出现原因不明的血小板进行性下降这一现象,虽然不能用来作为白血病复发的诊断,但对其早期复发有一定的预测作用.
목적 탐토백혈병환자이기인조혈간세포이식(Allo-HSCT)술후원인불명적혈소판(PLT)하강여백혈병복발지간적관계.방법 51례백혈병환자우2006년4월지2009년10월재아과접수료Allo-HSCT술,기중5례환자재술후2년내출현료복발,아문회고성분석료기복발전외주혈PLT계수、골수형태학급식입상태적동태변화.결과 5례이식후복발환자이식조기중성립세포화PLT조혈중건평균시간분별위15.8、25.8 d.당PLT계수강지50×109/L좌우시,골수거핵세포진일보감소,골수유치세포비솔수교PLT개시하강시유소증다,단균미체도복발적표준,STR검사소유환자종FDC전변위진전성혼합형감합체(PMC);5례환자재차후적3개월내선후발생형태학복발,복발시골수거핵세포궤호소실,STR검사제1례환자잉위PMC외,기여4례환자균전변위식입실패;통계학분석발현Allo-HSCT술후PLT진행성하강가교출현PMC제전평균75 d、형태학복발제전평균164 d.결론 백혈병환자Allo-HSCT술후출현원인불명적혈소판진행성하강저일현상,수연불능용래작위백혈병복발적진단,단대기조기복발유일정적예측작용.
Objective To explore the relationship between unexplained decline in platelets (PLT) and relapse in leukemia patients after allo-geneic haematopoietic stem cell transplantation(Allo-HSCT). Methods Fifty-one patients with leukemia received Allo-HSCT in our department between April 2006 to October 2009 and 5 of them relapsed within 2 years after transplantation.We retrospectively analyzed the dynamic alteration about the platelets in peripheral blood, bone marrow morphology and the state of implantation in the 5 relapsed patients. Results The average reconstitution time for granulocytes and PLTs was respectively 15.8 days and 25.8 days in the 5 relapsed patients. When PLTs decreased to about 50×109/L, megakaryocytes in bone marrow in all the five patients further reduced. The radio of blast cells in bone marrow increased compared with that when PLT started to decline, but failed to meet the criteria for relapse. STR for all five patients had transformed from FDC to progressive mixed chimerism (PMC). The five patients occurred morphological relapse in the subsequent three months. When the relapse happened, megakaryocytes in bone marrow almost disappeared, STR in 4 patients had transformed to graft failure(GF),except one case was still in PMC. Statistical analysis showed that the progressive decline in PLTs could be an average of 75 days in advance than the appearance of PMC, and an average of 164 days than morphological relapse in the five relapsed patients. Conclusions Although the phenomenon that unexplained progressive decline in PLTs in leukemia patients after Allo-HSCT can not be used as a diagnosis for leukemia relapse, it may be a predict for the early relapse.