MAG方案对恶性血液病患者造血干细胞动员作用的研究  

Mobilization of peripheral blood stem cells with mitoxantrone and high-dose cytarabine chemotherapy and rhG-CSF in patients with hematopoietic malignancies

作　　者：仇惠英[1] 吴德沛[1] 孙爱宁[1] 常伟荣[1] 金正明[1] 苗瞄[1] 唐晓文[1] 沈益明[1] 傅琤琤[1] 

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液病研究所,215006

出　　处：《中华血液学杂志》2004年第8期462-465,共4页Chinese Journal of Hematology

基　　金：江苏省卫生厅重点基金资助项目 (H9816);江苏省医学重点人才基金资助项目 (RC2 0 0 2 0 3 3 )

摘　　要：目的　研究米托蒽醌 (MTZ)联合大剂量阿糖胞苷 (Ara C)、重组人粒细胞集落刺激因子(rhG CSF)组成MAG方案对恶性血液病患者外周血干细胞的动员作用。方法　 1995年 12月至2 0 0 3年 4月 ,采用MAG方案对 14例恶性淋巴瘤和 2 9例急性白血病患者外周血干细胞进行动员 ,其用量为MTZ 10mg/m2 ,第 2 ,3天 ;Ara C 2 g/m2 ,每 12h 1次 ,第 1,2天 ;rhG CSF 30 0 μg/d。首先用MA方案联合化疗 ,白细胞 <1.0× 10 9/L时开始用rhG CSF ,白细胞回升时用CS 30 0 0plus或CobeSpectra血细胞分离机采集外周血干细胞。结果　 14例恶性淋巴瘤患者除 1例外周血干细胞采集失败外 ,其余 13例均 1次性采集成功 ,所得单个核细胞 (MNC) (3.91± 2 .70 )× 10 8/kg ,CD34+ 细胞 (17.79± 12 .90 )× 10 6/kg。采集 2 9例急性白血病患者外周血干细胞平均 2 .13次 ,2 4例采集成功 ,5例采集失败 ,所得MNC (3.6 2± 2 .89)× 10 8/kg ,CD34+ 细胞 (7.37± 6 .6 0 )× 10 6/kg。rhG CSF平均使用时间为 7d。经MAG方案动员后 ,除 8例患者有胃肠道反应、14例患者骨髓抑制期合并感染外无明显不良反应 ,无动员相关死亡。MAG方案动员后进行微小残留病检测 ,部分病例转为阴性。Objective To evaluate the efficacy of mitoxantrone combined high dose of cytarabine and recombinant human granulocyte colony-stimulating factor(MAG) regimen for mobilizing autologous peripheral blood stem cells (APBSC) in patients with hematopoietic malignancies. Methods From December 1995 to April 2003, 14 lymphoma and 29 acute leukemia patients were treated with high-dose cytarabine (2 g/m 2 every 12 h, days 1 and 2) and mitoxantrone (10 mg/m 2, days 2 and 3), followed by 300 microgram recombinant human granulocyte colony-stimulating factor per day(rhG-CSF 300 μg/d) i.e, the MAG regimen as mobilization regimen of peripheral blood stem cells. rhG-CSF was given subcutaneouly when the white blood cell (WBC) count below 1.0×10 9/L following the MA chemotherapy, APBSC were harvested when WBC count increased using Baxter CS3000plus or Cobe Spectra. Results Mobilization was successful in 13 of 14 lymphoma patients with MNC (3.91±2.70)×10 8/kg,CD34 + cells (17.79±12.90)×10 6/kg. Meanwhile, mobilization was successful in 24 of 29 acute leukemia patients with average of 2.13 times for apheresis. The median MNC and CD34 + cells yielded were 3.62×10 8/kg and 7.37×10 6/kg respectively, rhG-CSF was used for a median time of 7 days. Excepting for gradeⅠ～Ⅱgastrointestinal toxicity in 8 and infection in 14 cases, no major side effects were observed. There was no mobilization-related mortality. Minimal residual diseases became undetectable after mobilization in some patients. Conclusion MAG is a safe and highly effective mobilization regimen in patients with lymphoma and acute leukemia.

关 键 词：MAG方案 恶性血液病 造血干细胞 米托蒽醌 血液肿瘤 

分 类 号：R733[医药卫生—肿瘤]