化疗后恰当时机使用G-CSF能显著提高自体外周血干细胞移植物中CD34^+细胞的含量  

Yield of CD34^+ Cells in Graft Can Be Increased Significantly by G-CSF Used at Appropriate Time after Chemotherapy for AutoPBSCT

作　　者：徐黎[1] 常春康[1] 干蔚瑾 苏基滢[1] 张曦[1] 吴凌云[1] 宋陆茜[1] 贺琪[1] 周立宇[1] 肖超[1] 刘宏[1] 李晓[1] 

机构地区：[1]上海交通大学附属第六人民医院血液科,上海200233 [2]NYU Child Study Center,New York University School of Medicine,New York

出　　处：《中国实验血液学杂志》2011年第3期759-763,共5页Journal of Experimental Hematology

摘　　要：本研究旨在观察COAEP化疗后选择不同时机使用G-CSF对动员自体外周血干细胞(PBSC)产率的影响。选择39例恶性淋巴瘤(NHL和HD)或多发性骨髓瘤(MM)患者,接受相同的动员化疗方案(COAEP),包括CTX400mg/m2d1,VLB2mg/m2d1,Ara-C60mg/m2×d1-5,VP-16 60mg/m2×d1-5,prednisone40mg/m2×d1-5。历史对照组(12例)在化疗后外周血白细胞降至最低点首次回升时使用G-CSF(filgrastim)。试验组(27例)在外周血白细胞稳定回升(白细胞在首次回升后仍会出现波动2-3天)时使用G-CSF。G-CSF以5μg/kg每天1次皮下注射直至最后1次PBSC采集前。2组患者开始使用G-CSF后每日进行血常规检查,当白细胞总数大于10.0×109/L,单个核细胞(MNC)大于1.0×109/L时使用COBE血细胞分离机,以自动干细胞分离程序采集PBSC。结果表明,2组病例都使用了烷化剂(累积剂量无统计学差异),试验组获得26.4×106/kg CD34+细胞,显著高于历史对照组3.1×106/kg CD34+细胞(p=0.0031)。结论 :化疗后选择恰当的时机使用G-CSF能显著提高移植物中CD34+细胞含量。This study was aimed to investigate the influence of timing using G-CSF after chemothrapy on graft yield of mobilized peripheral blood stem cells for autoPBSCT. 39 patients with lymphoma or multiple myeloma （MM） received the same chemotherapy mobilization regimen, including CTX 400 mg/m2 dl ; VLB 2 mg/m2 dl ; Ara-C 60 mg/m2 ×dl - 5 ; VP-16 60 mg/m2 ×dl - 5 ; and prednisone 40 mg/m2 × dl - 5. The historical control group （ 12 cases） received G-CSF subcutaneously （filgrastim） at the first restoration after the initial nadir of the peripheral WBC count. The experimental group （27 cases） received G-CSF during the steady rise of the WBC count （end of fluctuating after initial nadir）. G-CSF was given in a single daily subcutaneous dose of 5 μg/kg until the final PBSC apheresis. When the peripheral WBC and mononuclear cell （MNC） counts reached 10× 109/L and 1.0 × 109/L respectively, leukapheresis was carried out using the COBE Spectrablood cell separator. The results indicated that despite there was comparable treatment with alkylating agents between 2 groups, a significantly increased yield of CD34 positive cells was observed in the experimental group（26.4 × 106/kg）, as compared to the historical control group （3.1× 106/kg） （p = 0. 0031 ）. It is concluded that the appropriate timing for the use G-CSF mobilization after chemotherapy is important to increase the CD34＋ cell yield in auto-graft.

关 键 词：自体外周血干细胞移植 CD34+细胞 G-CSF动员 化疗 

分 类 号：R457.7[医药卫生—治疗学] R730.5[医药卫生—临床医学]