内容紹介
Fresh Frozen Plasma Provides Endothelial Protection When Administered Early after Stem Cell Transplantation
Summary
Background: Veno-occlusive disease(VOD)is a fatal coagulopathy, which is caused by an endothelial disorder among patients who undergo hematopoietic stem cell transplantation(SCT). Some protective agents, such as administration of fresh frozen plasma(FFP), have been evaluated for both prophylactic and targeted therapy. Purpose: We evaluated the prophylactic efficacy of FFP for VOD in a retrospective study. Methods: We surveyed patients who received SCT in our hospital between January 2011 and December 2011. We reviewed their data and compared those who were administered prophylactic FFP in the early transplantation period(up to day 60)with those who did not receive prophylactic FFP. Results: A total of 14 cases were evaluated: 7 female and 7 male, with a median age of 50 years(range of 24 to 63 years). Fibrinogen significantly increased in the FFP group compared with the non-FFP group(p=0.0125). Although the hemostasis parameters of prothrombin time, activated partial thromboplastin time, and D-dimer were all comparable between the 2 groups, the level of fibrinogen degradation products(FDP)was significantly attenuated in the FFP group compared with the non-FFP group(p=0.0140). Of note, we observed 2 peaks in the D-dimer/FDP ratio in the engraftment period(around day 18)and post-engraftment(around day 35)compared with the non-FFP group. Overall survival did not significantly differ between the 2 groups(502 days for FFP, and 586 days for non-FFP, p=0.777). Discussion: Prophylactic administration of FFP improved hypofibrinogenemia and FDP accumulation in this retrospective analysis of patients who received SCT. We speculate that prophylactic FFP treatment for dyscoagulopathy is effective due to supplementation of coagulation factors. Further study, including randomized trials, is warranted in order to confirm this hypothesis.
要旨
造血幹細胞移植(SCT)の際に生じる重篤な合併症である肝中心静脈閉塞症(VOD)は,肝臓中心静脈の内皮障害に伴う致死的な血液凝固異常症が基本病態である。原因は単一ではなく,病態も十分解明されていないが,新鮮凍結血漿(FFP)による予防効果が推測されている。そこでわれわれは,当院において2011年1月1日～2011年12月31日までの1年間で同種SCTを実施した症例群のうち,早期FFP投与を行った症例とFFP非投与症例の2群比較を行った。対象症例は14(男性7,女性7)例,年齢の中央値は50歳,平均値47歳,範囲24～63歳であった。早期FFP投与群とFFP非投与群の移植後60日間までの検査値比較では,fibrinogenとFDPがFFP投与群で有意に改善していた。FFP投与群ではfibrinogenに代表される凝固線溶状態が改善し,それに伴って線溶マーカー異常の出現が予防できる可能性が推察された。
目次
Summary
Background: Veno-occlusive disease(VOD)is a fatal coagulopathy, which is caused by an endothelial disorder among patients who undergo hematopoietic stem cell transplantation(SCT). Some protective agents, such as administration of fresh frozen plasma(FFP), have been evaluated for both prophylactic and targeted therapy. Purpose: We evaluated the prophylactic efficacy of FFP for VOD in a retrospective study. Methods: We surveyed patients who received SCT in our hospital between January 2011 and December 2011. We reviewed their data and compared those who were administered prophylactic FFP in the early transplantation period(up to day 60)with those who did not receive prophylactic FFP. Results: A total of 14 cases were evaluated: 7 female and 7 male, with a median age of 50 years(range of 24 to 63 years). Fibrinogen significantly increased in the FFP group compared with the non-FFP group(p=0.0125). Although the hemostasis parameters of prothrombin time, activated partial thromboplastin time, and D-dimer were all comparable between the 2 groups, the level of fibrinogen degradation products(FDP)was significantly attenuated in the FFP group compared with the non-FFP group(p=0.0140). Of note, we observed 2 peaks in the D-dimer/FDP ratio in the engraftment period(around day 18)and post-engraftment(around day 35)compared with the non-FFP group. Overall survival did not significantly differ between the 2 groups(502 days for FFP, and 586 days for non-FFP, p=0.777). Discussion: Prophylactic administration of FFP improved hypofibrinogenemia and FDP accumulation in this retrospective analysis of patients who received SCT. We speculate that prophylactic FFP treatment for dyscoagulopathy is effective due to supplementation of coagulation factors. Further study, including randomized trials, is warranted in order to confirm this hypothesis.
要旨
造血幹細胞移植(SCT)の際に生じる重篤な合併症である肝中心静脈閉塞症(VOD)は,肝臓中心静脈の内皮障害に伴う致死的な血液凝固異常症が基本病態である。原因は単一ではなく,病態も十分解明されていないが,新鮮凍結血漿(FFP)による予防効果が推測されている。そこでわれわれは,当院において2011年1月1日～2011年12月31日までの1年間で同種SCTを実施した症例群のうち,早期FFP投与を行った症例とFFP非投与症例の2群比較を行った。対象症例は14(男性7,女性7)例,年齢の中央値は50歳,平均値47歳,範囲24～63歳であった。早期FFP投与群とFFP非投与群の移植後60日間までの検査値比較では,fibrinogenとFDPがFFP投与群で有意に改善していた。FFP投与群ではfibrinogenに代表される凝固線溶状態が改善し,それに伴って線溶マーカー異常の出現が予防できる可能性が推察された。