白细胞单采术在不同血液系统恶性疾病高白细胞中的应用及疗效  

Application and Efficacy of Leukapheresis in Different Hematological Malignancies with Hyperleukocytosis

作　　者：陆天宇 沙萍萍 冯宇锋[1] 崔庆亚[1] 朱子玲[1] 吴德沛[1] LU Tian-yu;SHA Ping-ping;FENG Yu-feng;CUI Qing-ya;ZHU Zi-ling;WU De-pei(The First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院,江苏省血液研究所,国家血液系统疾病临床医学研究中心,江苏苏州215006

出　　处：《中国血液流变学杂志》2021年第3期333-336,共4页Chinese Journal of Hemorheology

基　　金：国家自然科学基金青年基金项目(81900175)。

摘　　要：目的探讨白细胞单采术在不同血液系统恶性疾病高白细胞中的应用及疗效。方法运用COBE Spectra血细胞分离机对183例高白细胞血液系统恶性疾病患者进行296次紧急白细胞单采术并分析其疗效。结果183例患者中,男性100例,女性83例;急性髓系白血病(AML)占50%,慢性粒细胞白血病(CML)占17%,ph阴性和阳性急性B淋巴细胞白血病(B-ALL)分别占14%和9%,急性T淋巴细胞白血病(T-ALL)占7%,滤泡型淋巴瘤白血病(FL)占3%。单采时,白细胞数(50~100)×10^(9)/L组患者有72例,白细胞数(101~200)×10^(9)/L组有134例,白细胞数>200×10^(9)/L组有90例。经治1次白细胞单采术后,外周血平均白细胞数由(178.5±6.5)(53.1~796.1)×10^(9)/L降至(114.1±5.6)(22.6~586.9)×10^(9)/L。在不同疾病类型中,与CML患者相比,AML和ph阴性B-ALL患者在第一次白细胞单采后白细胞下降更明显(60.7×10^(9)/L vs.97.5×10^(9)/L,P=0.0314;70.5×10^(9)/L vs.97.5×10^(9)/L,P=0.0277)。在白细胞数(50~100)×10^(9)/L组患者中,一次单采后各种疾病白细胞数下降差异无统计学意义;白细胞数(101~200)×10^(9)/L组患者中,ph阴性B-ALL和AML与CML患者相比,白细胞分别下降89.9×10^(9)/L vs.32.0×10^(9)/L(P=0.0001)和63.5×10^(9)/L vs.32.0×10^(9)/L(P=0.0102);白细胞数>200×10^(9)/L组患者中,ph阴性B-ALL和CML患者相比,白细胞数下降差异有统计学意义(141.6×10^(9)/L vs.96.3×10^(9)/L,P=0.0033)。在不同白细胞数3组中,白细胞单采后白细胞分别下降37.7(-4.8~60.1)×10^(9)/L,60.9(5.5~132.8)×10^(9)/L和91.6(6.4~469.0)×10^(9)/L(P<0.0001);AML患者白细胞单采后白细胞分别下降39.2(13.8~60.1)×10^(9)/L,61.2(10.7~113.0)×10^(9)/L和85.5(26.2~149.0)×10^(9)/L(P<0.0001);B-ALL患者白细胞单采后白细胞分别下降37.5(-4.8~56.0)×10^(9)/L,77.2(22.0~132.8)×10^(9)/L和130.4(86.3~215.2)×10^(9)/L(P<0.0001);T-ALL患者白细胞单采后白细胞分别下降34.3(15.5~55.3)×10^(9)/L,59.6(38.9~81.5)×10^(9)/L和120.9(47.4~190.5)×10^(9)/L(PObjective To explore the application and efficacy of leukapheresis in different hematological malignancies with hyperleukocytosis.Methods The COBE Spectra blood cell separator was used to perform 296 emergency leukapheresis on 183 patients with hyperleukocytic hematological malignancies.Clinical efficacy was compared and analyzed.Results Of the 183 patients(100 males and 83 females),50%were acute myeloid leukemia(AML),17%were chronic granulocytic leukemia(CML),14%were ph-negative B-cell acute lymphocytic leukemia(B-ALL),9%were ph-positive B-ALL,7%were T-cell acute lymphocytic leukemia(T-ALL),and 3%were follicular lymphoma leukemia(FL).Before leukapheresis,there were 72 patients in the WBC count(50-100)×10^(9)/L group,134 patients in the WBC count(101-200)×10^(9)/L group,and 90 patients in the WBC count>200×10^(9)/L group.After first leukapheresis treatment,the average WBC count decreased from(178.5±6.5)(53.1-796.1)×10^(9)/L to(114.1±5.6)(22.6-586.9)×10^(9)/L.Compared with CML,AML and phnegative B-ALL patients had significant WBC decline(60.7×10^(9)/L vs.97.5×10^(9)/L,P=0.0314;70.5×10^(9)/L vs.97.5×10^(9)/L,P=0.0277).In patients with a WBC count of(50-100)×10^(9)/L,there was no difference in the decrease of WBC count of various diseases.In patients with a WBC count of(101-200)×10^(9)/L,WBC decreased significantly more in patients with ph-negative B-ALL(89.9×10^(9)/L vs.32.0×10^(9)/L,P=0.0001)and AML(63.5×10^(9)/L vs.32.0×10^(9)/L,P=0.0102)than in patients with CML.In patients with a WBC count>200×10^(9)/L,there was a significant difference in the decrease of WBC count compared to patients with ph-negative B-ALL and CML(141.6×10^(9)/L vs.96.3×10^(9)/L,P=0.0033).In the 3 groups with different WBC counts,WBC decreased by 37.7(-4.8-60.1)×10^(9)/L,60.9(5.5-132.8)×10^(9)/L and 91.6(6.4-469.0)×10^(9)/L after first leukapheresis in all patients(P<0.0001).WBC decreased by 39.2(13.8-60.1)×10^(9)/L,61.2(10.7-113.0)×10^(9)/L and 85.5(26.2-149.0)×10^(9)/L in AML patients(P<0.0001).WBC decreased by 37.

关 键 词：急性白血病 高白细胞血症 紧急白细胞单采术 

分 类 号：R733.7[医药卫生—肿瘤] R730.51[医药卫生—临床医学]