多西他赛联合重组人粒细胞集落刺激因子动员乳腺癌患者外周血干细胞的效果及影响因素分析

Clinical Study on Efficacy of Docetaxel Combined with G-CSF for Mobilization of Peripheral Blood Stem Cell in Metastatic Breast Cancer Patients

目的研究多西他赛联合重组人粒细胞集落刺激因子(rhG-CSF)在乳腺癌患者动员外周血干细胞(peripheral blood stem cell,PBSC)的效果及影响因素。方法 2006年2月—2009年6月我科收治的55例行多西他赛(商品名多帕菲,TXT,120mg/m2持续静脉滴注3h)动员的乳腺癌患者,化疗后白细胞降至1.0×109/L左右时使用rhG-CSF5μg/(kg.d)动员至采集结束。并进一步分析患者年龄、化疗后白细胞最低数、采集前各类血细胞数、内脏、骨转移情况及化、放疗情况对采集单个核细胞(mononuclearcell,MNC)和CD34+细胞的影响。结果多西他赛化疗动员后中位7d白细胞降至1.0×109/L左右,皮下注射rhG-CSF中位3d,采集总MNC平均(5.51±1.24)×108/kg,采集总CD34+细胞平均(2.90±1.38)×106/kg。年龄、化疗后白细胞最低数与采集CD34+细胞均显著相关(P<0.05)。化疗的周期数≤6的患者采集平均CD34+细胞数较周期数≥6患者显著增高(P<0.05)。无1例患者出现严重不良反应。结论 TXT(120mg/m2持续静脉滴注3h)联合rhG-CSF为转移性乳腺癌患者动员的有效安全方案。患者年龄、既往化疗周期数显著影响患者CD34+细胞的采集数量。患者化疗后白细胞最低数可作为采集CD34+细胞数量的预测指标。

Objective To study the efficacy and factors that affect the efficacy of Doctaxel Combined rhG-CSF for peripheral blood stem cell（PBSC）mobilization for patients with breast cancer.Methods Fifty five patients with breast cancer were included in our study.TXT at the dose of 120 mg/m2 was given continuously for 3 hours.When the number of white blood cell was less than 1.0×109/L,rhG-CSF was given until the end of leukopheresis.CD34＋ cells collected by a continuous flow cell separator from peripheral blood were analyzed with FACS.Various elements might affecting the yield of CD34＋,including age,the lowest number of leucocyte after chemotherapy,the blood cell count before leukopheresis,visceral or bone metastases,prior chemotherapy and radiotherapy,were analyazed.Results The leukopheresis was started on the median 10th day after mobilization chemotherapy.The mean number of MNC and CD34＋ cells were（5.51±1.24）×108/kg and（2.90±1.38）×106/kg respectively.The age and the lowest number of leucocyte were related with CD34＋ cells number.The CD34＋ cells number was higher in patients with the cycles of chemotherapy less than or equal to 6 than that in the matched group（P0.05）.No serious adverse side effect was observed.Conclusion TXT plus rhG-CSF was an effective and safe mobilization regimen for autologous peripheral blood stem progenitor cells in patients with breast cancer.The age and prior chemotherapy cycles affected the number of CD34＋ cells collected.The lowest number of leucocyte may be a good predictor of CD34＋ cells collected.