粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合动员异基因造血干细胞移植

Allogeneic hemopoietic stem cell transplantation using mobilization with granulocyte colony stimulating factor and granulocyte-macrophage colony stimulating factor

背景:目前FDA已批准应用于临床外周血造血干细胞移植的动员剂只有粒细胞集落刺激因子和粒-巨噬细胞集落刺激因子,其中粒细胞集落刺激因子单药应用是目前最主要的动员方案,但可引起供者骨骼肌肉酸痛、发热等不良反应。目的:回顾性分析以粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合应用为动员方案的异基因造血干细胞移植临床效果。方法:选择2004-01/2009-10河南省人民医院血液科以粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子联合应用为动员方案进行血缘全相合异基因造血干细胞移植51例,分析移植物成分、造血重建及移植物抗宿主病的发生率。结果与结论:动员96h后CD34+细胞占单个核细胞的比例为(0.97±0.13)%,CD34+CD38-细胞占CD34+细胞的比例为(37.49±4.03)%;移植后的快速造血重建与CD34+细胞、CD34+CD38-细胞输入量呈负相关。Ⅰ度、Ⅱ～Ⅳ度急性移植物抗宿主病的发生率分别为25.5%,15.7%;局限性、广泛性慢性移植物抗宿主病的发生率分别为39.2%,21.2%。提示在血缘全相合异基因造血干细胞移植中,粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合可有效实现干细胞动员,所获CD34+细胞完全可以满足快速造血重建的需要;输入较多的CD34+细胞、CD34+CD38-细胞可能利于快速造血重建。

BACKGROUND：Currently,only granulocyte colony stimulating factor （G-CSF） and granulocyte-macrophage colony stimulating factor （GM-CSF） approved by Food and Drug Administration are used for the mobilization of peripheral blood hemopoietic stem cells and G-CSF alone or in combination with GM-CSF is the predominant mobilization regiments used in the allogeneic setting,but it might cause the donors some adverse events such as bone pain,muscular soreness and fever. OBJECTIVE：To retrospectively review the clinic results of allogeneic peripheral blood hemopoietic stem cell transplantation （allo-PBSCT） using mobilization with G-CSF and GM-CSF. METHODS：From January 2004 to October 2009,a total of 51 patients with hematological malignant diseases received allo-PBSCT from human leucocyte antigen-matched sibling donors mobilized with G-CSF and GM-CSF at the Department of Hematology,Henan Provincial People＇s Hospital. We analyzed components in the allografts,hematopoietic reconstitution and the incidence of graft versus host diseases （GVHD）. RESULTS AND CONCLUSION：After mobilizing 96 hours,the percentage of CD34＋ cells in mononuclear cells was （0.97±0.13）% and the percentage of CD34＋/CD38-cells in CD34＋ cells was （37.49±4.03）%. Rapid hematopoietic reconstruction posttransplantation was negatively associated with infused total CD34＋ and CD34＋/CD38-cell number. Incidences of Grades Ⅰ,Ⅱ–Ⅳ acute GVHD were respectively 25.5% and 15.7% of patients. The incidence rates of limited and extensive chronic GVHD were 39.2% and 21.2% separately. These results suggest the combination regimen with GM-CSF and G-CSF appear to have a good effect in the mobilization of peripheral blood stem cells and be sufficient to ensure early hematopoietic reconstitution. The high doses of infused CD34＋ and CD34＋CD38-cells are likely beneficial to the prompt engraftment.