中文摘要：

目的探讨非体外去除T细胞单倍体造血干细胞移植（HSCT）后血小板恢复的规律及其对预后的影响。方法回顾性分析2007年1月1日至2008年12月31日北京大学血液病研究所291例非体外去除T细胞单倍体HSCT患者的临床资料。根据移植后血小板恢复情况，将患者分为：①持续性血小板减少组：移植后第30天（＋30d）、＋60d、＋90d外周血PLT均〈50×10^9/L；②血小板不稳定组：＋30d或＋60d或＋90d外周血PLT≥50×10^9，但〈100×10^9VL；③血小板恢复组：＋90d外周血PLT≥100×10^9／L。分析各组患者血小板恢复规律、总生存（0s）率及移植相关死亡率（TRM）。结果291例患者中288例获得完全供者植入，中位粒细胞植入时间为13（9-29）d；中位血小板植入时间为17（7-180）d。＋100dⅢ-Ⅳ度急性移植物抗宿主病发生率为14．7％，移植后3年慢性移植物抗宿主病发生率为56．4％。3年OS率为64．6％，TRM为22．3％。至随访截止，262例患者脱离血小板输注。持续性血小板减少组、血小板不稳定组、血小板恢复组患者分别为71例（24．4％）、147例（50．5％）、73例（25．1％），三组患者移植后3年OS率分别为38．0％、69．4％、80．8％，TRM分别为53．5％、17．7％、1．4％，差异均有统计学意义（P〈0．05）。多因素分析显示持续性血小板减少与OS率降低及TRM上升相关。结论非体外去除T细胞单倍体HSCT后持续性血小板减少较为常见，血小板恢复较慢者预后较差。

英文摘要：

Objective To explore the kinetics of platelet reconstitution and its prognostic significance in patients received unmanipulated haploidentical stem cell transplantation （Haplo-HSCT） without in vitro T cell depletion. Methods A total of 291 patients received Haplo-HSCT without in vitro T cell depletion between January 2007 to December 2008 were retrospectively reviewed. They were categorized into 3 groups according to the platelet count on day 30, day 60 and day 90： （1）persistent thrombocytopenia （Group A） was defined as the platelet count never reached 50×10^9/L on the three time points; （2）unstable thrombocytopenia （Group B）： the platelet count recovered to a level of 50×10^9/L by day 30 or 60 or 90, yet did not reach a level of more than 100×10^9/L; （3）non-thrombocytopenia （Group C）： the platelet count was higher than 100×10^9/L on day 90. The kinetics of platelet reconstitution, overall survival （OS） and treatment related mortality （TRM） were compared between 3 groups. Results Of the 291 consecutive patients, 288 cases engrafted successfully and 262 cases were platelet transfusion independent. The median intervals of neutrophil and platelet engraftment were 13 （9-29） days and 17 （7-180） days, respectively. The cumulative incidence of grade Ⅲ-Ⅳ acute graft versus host disease （GVHD） on day 100 and chronic GVHD at 3 years were 14.7% and 56.4% respectively. OS and TRM at 3 years were 64.6% and 22.3% respectively. At the end of the follow-up, 266 cases were platelet transfusion independent： including 71 （24.4%） cases in Group A, 147 （50.5%） in Group B and 73 （25.1%） in Group C. OS in group A, B and C was 38.0%, 69.4% and 80.8% （P〈0.05） respectively. TRM in Group A, B and C was 53.5%, 17.7% and 1.4% （P〈0.05） respectively. Persistent thrombocytopenia was related with lower OS and higher TRM in multivariate analysis. Conclusion Persistent thrombocytopenia was common after Haplo-HSCT without in vitro T cell depletion, and patients