单个核细胞计数对异基因外周血干细胞移植后造血重建的预测研究

Mononuclear cells count can reliably predict hematopoietic reconstitution following allogeneic peripheral blood stem cell transplantation

目的探讨单个核细胞(MNC)计数作为造血干(祖)细胞含量的独立指标预测异基因外周血干细胞移植(allo-PBSCT)后造血重建的可行性。方法将暨南大学附属第一医院血液科2000年1月至2008年12月120例allo-PBSCT患者分为MNC组(83例)和CD34+细胞组(37例),MNC组以≥4×108/kg为采集目标,CD34+细胞组以≥4×106/kgCD34+细胞为采集目标。比较两种计数指标对造血重建和供者采集次数的影响,并分析不同MNC剂量对造血重建的影响。结果MNC组受者输入MNC的中位数为6.81×108/kg,CD34+细胞组受者输入CD34+细胞的中位数为5.05×106/kg;两组造血重建率均为100%;两组中性粒细胞植活的中位时间均为移植后第11天(P>0.05),血小板植活的中位时间均为移植后第12天(P>0.05);两组供者1次采集率分别为100%和37.84%(P<0.05);MNC组中HLA全相合与不全相合移植受者中性粒细胞植活的中位时间分别为移植后第11天和移植后第12天(P>0.05),血小板植活的中位时间分别为移植后第12天和移植后第14天(P>0.05);MNC剂量在(3～5.99)×108/kg递增时,剂量与造血重建呈正相关,而MNC剂量在达到6×108/kg后递增,则并未使植活时间随之进一步缩短。结论MNC计数单独作为造血干(祖)细胞含量的计数指标,不仅能可靠预示allo-PBSCT(包括HLA全相合与不全相合移植)后造血重建,其植活率和植活速度可与CD34+细胞相比拟,而且其供者1次采集率(100%)显著高于后者(37.84%),allo-PBSCT时MNC计数可取代CD34+细胞作为造血干(祖)细胞含量的独立指标。

Objective To explore the feasibility of mononuelear cells （MNC） count taken as an independent index for predicting hematopoietic reconstitution after allogeneic peripheral blood stem cell transplantation （ allo- PBSCT）. Methods We prospectively analyzed 120 patients who underwent allo-PBSCT in our BMT unit from January 2000 to December 2008. Patients were divided into 2 groups： MNC group（ 83 patients） and CD34^＋ cells group （37 patients）. The target recipient MNC dose collected was 4 x 10S/kg in MNC group, and the target recipient CD34 ^＋ cell dose was 4 × 10^6/kg in CD34 ^＋ cells group. Engraftment and number of apheresis procedure in the two groups were compared. Results A median of 6. 81×10^8 MNC/kg was infused into the recipients of MNC group, and a median of 5.05 × 10^6 CD34^ ＋ cells/kg was infused into the recipients of CD34^ ＋ cell group. All the recipients obtained complete hematopoietic reconstitution after transplantation（ 100% ）. The median time to neutrophil and platelet engraftment in the recipients in the two groups were 11 d and 11 d, respectively （ P 〉 0.05 ）, and 12 d and 12 d in the recipients in the two groups,respectively（ P 〉 0.05 ）. All the 83 donors in MNC group achieved the target dose in a single apheresis procedure（ 100% ） ,as compared with 14 donors in CD34 ^＋ cells group who achieved the target dose in a single apheresis procedure（37. 84% ）（ P = 0. 000）. The median time to neutrophil and platelet engraftment in the recipients who received HLA-matched and HLA-mismatched sibling donor transplantation were 11 d and 12 d, respectively （ P 〉 0. 05 ）, and 12 d and 14 d, respectively （ P 〉 0.05 ）. There was a positive correlation between the tempo of the engraftment and the progressive increase of the doses of MNC in the range of （3 - 5.99）× 10^8/kg, but which was not found in the range of 6 ×10^8/kg. Conclusion These results indicate that MNC taken as an index for the measurement of the hematopoietic stem cell/progenitor content can reliably predict hematopoietic reconstitution after both HLA-matched and -mismatched sibling donor peripheral blood stem cell transplantation, with the rate and tempo of engraftment comparable with that in CD34 ^＋ cell group, and however,the target dose was reached with one apheresis in all 83 donors in MNC group（ 100% ） ,as compared with lg donors in CD34^＋ ceil group（57.84% ） ,suggesting that MNC may replace CD34^＋ cell as an independent index for the assessment of the stem cell/progenitor content in clinical practice.