摘要
Objectives To investigate the efficacy of accelerating hemopoietic reconstraction and reducing a graft versus host disease (GVHD) in Allo-BMT receiving lenograstim stimulated donor marrow and to assess the preliminary biological mechanism .Methods The donors for thirty patients (study group) with leukemia were given lenograstim 3-4?μg*kg-1*d-1 for seven days prior to marrow harvest. The results of subsequent engraftment in the recipients was compared with fifteen donors without G-CSF (control group). Five donors themselves were studied to assess the effects of lenograstion on hematopoietic progenitor cells and lymphocyte subsets in BM.Results The stimulated bone marrow contained a higher number of nucleated cells, CFU-GM and CD34+ cells (P<0.01). The hematopoetic reconstitution was accelerated. Until granulocyte counts exceeded 0.5×109/L and plalete counts exceeded 20×109/L, the days were 16.7±3.2 and 18.4±3.0 days as compared with those of the control group (22.5±5.1 and 26.3±5.9 days respectively, P<0.01). The incidence of grade Ⅱ-Ⅳ aGVHD was very low, only one case with grade Ⅱ aGVHD on the skin in the study group. Four out of fifteen patients (26.7%) in the control group had grade Ⅱ-Ⅳ aGVHD (P<0.05). The number of T lymphocyte subsets in the harvested BM stimulated by G-CSF changed. In comparison with the control group, CD4+ decreased and CD8+ increased significantly (P<0.01). The changes of progenitor cells and T lymphocyte subsets in BM from pre- to post- G-CSF stimulation indicated that the percentage of CD4+ cells reduced (P<0.05), that of CD8+ cells, and that of CD34+ increased (P<0.01). The incidence of chronic GVHD and relapse of leukemia were not different significantly between both groups.Conclusions Allogenic bone marrow transplant (Allo-BMT) donors given G-CSF can accelerate engraftment and minimize the incidence of severe aGVHD. There is a trend in favour of improved transplant-related complicatians.
目的 研究异基因骨髓移植供者应用G CSF对加速造血重建与减轻急性GVHD的影响及其生物学机制。方法 30例白血病异基因骨髓移植供者应用G CSF为研究组 ,采髓前供者接受格拉诺赛特 3- 4 μg·kg 1·d 1,共 7天。 15例供者采髓前未用G CSF为对照组。比较其促造血恢复和减轻急性重度GVHD的疗效。 5例供者使用G CSF前后进行了自身对比 ,观察G CSF对骨髓中造血祖细胞和淋巴细胞亚群的影响。结果 与对照组比较 ,供者使用G CSF后 ,在采集相同的骨髓量中含较多有核细胞、CFU GM及CD34+数。加速造血重建 ,粒细胞计数 >0 5× 10 9/L与血小板 >2 0× 10 9/L分别为 16 7± 3 2与 18 4± 3 0 (对照组是 2 2 5± 5 1与 2 6 3± 5 9天 ,P <0 0 1)。急性重度GVHD发生率低 ,急性Ⅱ Ⅳ度GVHD发生率 3 3% ,仅 1例出现Ⅱ度皮肤急性GVHD ,对照组急性Ⅱ Ⅳ度GVHD发生率 2 6 7% (P >0 0 5)。供者应用G CSF与未使用G CSF对照组比较 ,CD34+百分率和CFU GM增殖增加 (P <0 0 1) ,CD4 +减少 (P <0 0 5) ,CD8+增加 (P >0 0 5)。二组慢性GVHD与复发率比较无差异。结论 异基因骨髓移植供者G CSF可加速造血重建 ,而且能减轻重度急性GVHD ,供者应用G CSF倾向改善移植相关死亡率。
