中剂量阿糖胞苷对急性髓系白血病外周血干细胞动员效果的影响  

Effect of intermediate-dose cytarabine on mobilization of peripheral blood hematopoietic stem cell in acute myeloid leukemia

作　　者：谢沐尘 张钰[1] 戴敏[1] 韦祁[1] 李小芳[1] 魏永强[1] 黄芬[1] 范志平[1] 江千里[1] 刘启发[1] 孙竞[1] 冯茹[1] 

机构地区：[1]南方医科大学南方医院血液科,广州510515

出　　处：《中华血液学杂志》2014年第7期587-591,共5页Chinese Journal of Hematology

摘　　要：目的 探讨外周血干细胞动员前中剂量阿糖胞苷（ID-Ara-C）化疗对急性髓系白血病（AML）动员效果的影响.方法 收集1999年8月至2012年11月接受自体造血干细胞动员的90例AML患者的临床资料.所有患者完全缓解后接受依托泊苷＋阿糖胞苷（EA）联合rhG-CSF方案进行外周血干细胞动员.白细胞恢复至4.0×109/L或监测外周血CD34＋细胞≥1％时进行外周血干细胞采集.回顾性分析动员前ID-Ara-C化疗对AML动员效果的影响.结果 根据ID-Ara-C化疗次数将患者分为A（＜2次）、B（2次）、C（＞2次）三组.A、B、C三组中位CD34＋细胞数分别为4.7×106/kg、2.7×106/kg、2.3×106/kg （P=0.003）.在可评估动员效果的87例患者中,CD34＋细胞数≥2.0×106/kg 61例（70.1％）,CD34＋细胞数＜2.0×106/kg 26例（29.9％）.在动员效果较差的26例AML患者中,A组7/46例（15.2％）,B组10/21例（47.6％）,C组9/20例（45.0％）（x2=10.05,P=0.007）.C组患者采集足够量的外周血干细胞所需要的采集次数、总循环血量、rhG-CSF应用时间及剂量最多（P＜ 0.05）.单因素分析显示动员前ID-Ara-C化疗次数及Ara-C累积量是动员效果的影响因素,而性别、年龄、预后分层、常规化疗与动员效果无显著相关性.多因素分析提示ID-Ara-C化疗次数是影响动员效果的唯一独立因素（OR=0.623,95％ CI=0.418～ 0.926,P=0.019）.结论 ID-Ara-C化疗次数是影响AML外周血造血干细胞动员的独立影响因素.拟行自体造血干细胞移植患者应酌情控制ID-Ara-C化疗的次数.Objective To explore the impact of courses of intermediate-dose cytarabine （ID-Ara-C） chemotherapy on the efficiency of hematopoietic stem cell mobilization in acute myeloid leukemia （AML） patients with autologous hematopoietic stem cell transplantation （auto-HSCT）.Methods 90 patients with de novo AML undergoing auto-HSCT between August 1999 and November 2012 were enrolled.All patients received the mobilization regimen of cytarabine and etoposide chemotherapy in combination with recombinant human granulocyte-colony stimulating factor （rhG-CSF）.Stem cell apheresis was scheduled when blood leukocyte count recovered greater than 4.0 × 109/L or the proportion of CD34＋ cells greater than 1％ in peripheral blood.The impact of ID-Ara-C courses on the mobilization efficiency was analyzed retrospectively.Results According to the ID-Ara-C courses,patients were divided into group A （＜ 2 courses）,B （2 courses）,and C （＞ 2 courses）.The median doses of CD34＋ cells （× 106/kg） in three groups were 4.7,2.7,2.3,respectively （P=0.003）.Of the available 87 patients who could be evaluated,61 （70.1％） cases had CD34＋ cells greater than 2.0 × 106/kg,and 26 （29.9％） cases less than 2.0 × 106/kg.Of the 26 patients without satisfactory mobilization efficiency,7 （15.2％） were in group A,10（47.6％） in group B,and 9（45.0％） in group C （x2=10.05,P=0.007）.In addition,patients with satisfactory mobilization efficiency （CD34＋ cells ≥2.0× 106/kg） in groups C needed more times of collection,more volume of blood processed,and even high-dose and longer course of rhG-CSF （P＜0.05）.In univariate analysis.The ID-Ara-C courses and the cumulative dose were significant correlate with mobilization efficiency.In multivariate analysis,the ID-Ara-C courses was an independent correlation factor for mobilization efficiency （odd ratio=0.623,95％ confidence interval=0.418-0.926,P=0.019）.The sex,age,cytogenetic risk,the standard chemotherapy courses did not correlate w

关 键 词：阿糖胞苷 造血干细胞动员 造血干细胞移植 白血病 髓样 急性 

分 类 号：R733.71[医药卫生—肿瘤]