一线应用兔源抗胸腺细胞球蛋白联合环孢素治疗成人重型再生障碍性贫血疗效分析
일선응용토원항흉선세포구단백연합배포소치료성인중형재생장애성빈혈료효분석
Combination of rabbit antithymocyte globulin and cyclosporine A as first-line therapy for adult severe aplastic anemia
  • 万方数据
    中华血液学杂志 중화혈액학잡지
    Chinese Journal of Hematology
    2011年 1期 38-42 ,共5页

    曹慧敏%王慧君%张莉%井丽萍%周康%杨栋林%李洪强%刘庆国%闫嶂松%刘永泽%吴玉红%储榆林%张凤奎

    조혜민%왕혜군%장리%정려평%주강%양동림%리홍강%류경국%염장송%류영택%오옥홍%저유림%장봉규

    贫血,再生障碍性%成人%免疫抑制治疗%治疗结果 貧血,再生障礙性%成人%免疫抑製治療%治療結果
    빈혈,재생장애성%성인%면역억제치료%치료결과
    Anemia,aplastic%Adults%lmmunosuppressive therapy%Treatment outcome
    目的 研究成人重型再生障碍性贫血(SAA)一线应用兔源抗胸腺细胞球蛋白(r-ATG)联合环孢素(CsA)免疫抑制治疗(IST)的疗效及不良反应.方法 回顾性分析我院2003年至2008年贫血诊疗中心收治的79例成人初始SAA或极重型再生障碍性贫血(VSAA)患者临床资料,评价IST疗效及分析相关因素.结果 6例患者早期死亡,73例患者可进行疗效评价,60例(82.2%)获得治疗反应,获得治疗反应的患者脱离输注血制品的中位时间为60 d.32例SAA患者均获治疗反应,治疗反应率(100%)高于41例VSAA组患者的68.3%(P=0.001).获得G-CSF治疗反应的患者较无反应者IST疗效明显增高(100%对67.5%,P=0.001).共61例(77.2%)患者出现血清病反应.获得治疗反应的患者3例复发,2例发生克隆性血液学异常.应用该方法治疗,患者预计3年总生存率为88.9%.结论 一线应用r-ATG联合CsA治疗成人SAA疗效高,不良反应轻微.
    목적 연구성인중형재생장애성빈혈(SAA)일선응용토원항흉선세포구단백(r-ATG)연합배포소(CsA)면역억제치료(IST)적료효급불량반응.방법 회고성분석아원2003년지2008년빈혈진료중심수치적79례성인초시SAA혹겁중형재생장애성빈혈(VSAA)환자림상자료,평개IST료효급분석상관인소.결과 6례환자조기사망,73례환자가진행료효평개,60례(82.2%)획득치료반응,획득치료반응적환자탈리수주혈제품적중위시간위60 d.32례SAA환자균획치료반응,치료반응솔(100%)고우41례VSAA조환자적68.3%(P=0.001).획득G-CSF치료반응적환자교무반응자IST료효명현증고(100%대67.5%,P=0.001).공61례(77.2%)환자출현혈청병반응.획득치료반응적환자3례복발,2례발생극륭성혈액학이상.응용해방법치료,환자예계3년총생존솔위88.9%.결론 일선응용r-ATG연합CsA치료성인SAA료효고,불량반응경미.
    Objective To analyze the efficacy and side-effects of combination of rabbit antithymocyte globulin (ATG) and cyclosporine A(CsA) as the first-line immunosuppressive therapy (IST) for adult severe aplastic anemia ( SAA ) patients. Methods Adult SAA or very severe aplastic anemia ( VSAA ) patients treated with rabbit ATG + CsA as first line therapy in our hospital from 2003 to 2008 were retrospectively analysed and the therapeutic response relevant factors were analysed. Results Seventy-nine patients were enrolled. Of all these patients, 6 died within 3 months after IST. The overall response rate was 82.2% and the median time to transfusion independent was 60 days. The therapeutic response rate in 32 SAA patients ( 100% ) was significantly higher than that in 41 VSAA cases (68.3%) ( P = 0.001 ). Patients with neutrophil response to G-CSF treatment had a higher IST response rate than those without response to G-CSF ( 100% vs 67.5%, P=0.001 ). Sixty-one patients (77.2%) occurred serum sickness reaction. Three patients relapsed and two developed clonal hematological abnormdities after IST. The 3-year overall survival for all the patients was 88.9%. Conclusions Rabbit ATG in combination with CsA as first-line IST for adult SAA can lead to excellent treatment outcomes with minor adverse effects.
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