rhG-CSF动员的儿童自体外周血干细胞冻存后回输的毒副作用研究  

Relevant Low Toxicities with rhG-CSF Mobilized and Cryopre-served Autologous Peripheral Blood Stem Cell Return Infusions in Children

作　　者：王建文[1] 唐锁勤[1] 吕善根[1] 冉崇容[1] 扬光[1] 刘英[1] 高晓宁[1] 

机构地区：[1]解放军总医院小儿内科,北京100853

出　　处：《中国实验血液学杂志》2007年第2期404-407,共4页Journal of Experimental Hematology

摘　　要：本研究探讨儿童患者中冻存自体外周血造血干细胞回输的相关毒性。对35例恶性肿瘤患儿经大剂量化疗或大剂量化疗加放疗的预处理后,进行解冻后的冻存自体外周血造血干细胞分次快速回输,对70例次输注进行了毒性评定。全部病人采用化疗加重组人粒细胞刺激因子(rhG-CSF)进行动员,以CS-3000 plus型或COBE spec-tra-4型血细胞分离机采集外周血造血干细胞。移植物置于10%二甲亚砜(DMSO)中冷冻,并保存在液氮中。35例恶性肿瘤患儿输注总量190-420ml(265±73ml,相当于13.7±4.2ml/kg),含干细胞数(4.43±1.91)×108/kg,DMSO平均输注总量0.94±0.18g/kg。单次输注量90-300ml(132±37ml,相当于6.6±5.2ml/kg),DMSO0.68±0.12g/kg,同时观察并记录输注过程中出现的症状,并监测输注后24小时内脉搏、血压、体温、呼吸频率,每15分钟记录1次。输注前、后检测血清钾、钠、肌酐、总胆红素、天门冬氨酸转移酶和丙氨酸转移酶及尿液检测。结果表明:回输后出现轻微相关毒性,诸如血红蛋白尿(77.1%)、头痛(40.0%)、恶心(34.3%)、呕吐(24.3%)、腹痛(11.4%)、心动过速(10.0%)、心动过缓(5.7%),但无休克等严重毒性反应。血胆红素在输注后有所升高。输注量>200ml的患者,其血红蛋白尿、头痛、恶心、呕吐和腹痛的发生率有升高趋势(P<0.01),仍可迅速消失。首次输注后总胆红素有升高(P<0.01),并观察到输注后胆红素升高程度与输注量明显相关(r=0.8977,P<0.01)。结论:冻存的儿童自体外周血造血干细胞分次回输的相关毒副作用较轻,发生率较低,头痛、恶心、呕吐的发生率与单次回输量有关。The purpose of this study was to evaluate the safety of cryopreserved and thawed peripheral blood stem cell （PBSC） fractionated return infusions in children. 35 chilood patients with malignant tumors （13 acute leukaemias, 15 neuroblastomas and 7 malignant lymphomas） received fractionated return infusions of cryopreserved stem cells after undergoing high-dose chemotherapy without or with total body irradiation. The toxicities of 70 return infusions were evaluated. All patients were mobilized by chemotherapy plus recombination human granulocyte colonystimulating factor （rhG-CSF）, and then PBSCs were collected by a separator CS-3000 plus or COBE spectra-4. The grafts were eryopreserved in 10% dimethyl sulfoxide （DMSD） and stored in liquid nitrogen. There were totally 70 PBSC transfusions. The total volume of PBSCs transfused： 190 -420 ml （265 ±73 ml or 13.7 ±4.2 mi/kg） with a mean of （4.43 ±1.91） × 10^8/kg of PBSCs, and 0.94 ±0.18 g/kg of DMSO. The single dose： 90-300 ml（132 ±37 ml or6. 6 ±5.2 mi/kg） with a mean of 0.68 ±0.12 g/kg of DMSO. Symptoms occurring during the infusions were recorded. All patients were monitored for 24 hours after infusion. Pulse, blood pressure, body temperature, and respiratory rate were recorded every 15 minutes. At four hours before and 8 hours after infusion, urinalysis was performed. Serum potassium, sodium, crealinine, total bilirubin, aspartate amino transferase （AST）, and alanine amino transferase （ALT） levels were examined within 24 hours before and after the first infusion. The results showed that the toxicities observed included hemoglobinuria in 54 retun infusions （77. 1% ）, headache in 28 （40.0%）, nausea in 24 （34.3%）, vomiting in 17 （24.3%）, and abdominal pain in 8 （ 11.4% ）. Patients who received a graft 〉 200 ml tended to have a higher frequency of hemoglobinuria, headache, nausea, vomiting, or abdominal pain （P 〈0.01 ）, and they disappeared quickly, too. Total bilirubin increased after the first re

关 键 词：自体造血干细胞移植 rhG—CSF动员 自体外周血造血干细胞回输 儿童血液病 

分 类 号：R457.7[医药卫生—治疗学]