丹参酮联合rhG-CSF动员自体外周血造血干细胞的疗效分析

Curative effect of Tanshinone combine rhG-CSF mobilize autologous peripheral blood stem cells

目的研究丹参酮联合重组人粒细胞集落刺激因子(rhG-CSF)方案,对多次化疗血液肿瘤患者自体外周血造血干细胞移植动员效果。方法回顾性分析2008年11月至2010年12月采用丹参酮联合rhG-CSF和单用rhG-CSF动员方案动员外周血造血干细胞疗效。结果丹参酮联合rhG-CSF组中,28例1次采集充足,3例(均为双次移植)采集2次,平均采集MNC数8.6×108个/千克[(6.1~12.3)×108个/千克],CD34+细胞5.9×106个/千克[(2.5~10.3)×106个/千克];单用rhG-CSF组中,26例1次采集充足,9例(2例为双次移植)采集2次,平均采集MNC数7.3×108个/千克[(4.4~10.9)×108个/千克],CD34+细胞4.1×106个/千克[(2.0~8.7)×106个/千克],P<0.05。造血干细胞移植预处理后,所有患者均达到明显骨髓抑制,丹参酮联合rhG-CSF组,中性粒细胞恢复到0.5×109/L,时间为+10.4 d(+8^+14 d),造血干细胞移植后第1天开始计算为+1 d;PLT恢复到20×109/L,时间为+13.8 d(+10^+17 d);单用rhG-CSF组,中性粒细胞恢复到0.5×109/L,时间为+10.8 d(+8^+15 d),P>0.01,PLT恢复到20×109/L,时间为+14.2 d(+11^+19 d),P>0.01。结论丹参酮联合rhG-CSF动员方案可显著提高自体外周血造血干细胞动员效果,保证移植后造血功能的重建。对于高龄、反复化疗患者是一种安全、有效的动员造血干细胞的方法,临床疗效满意,值得推广。

Objective To study the curative effect of Tanshinone combine recombinant human granulocyte colony stimulating factor （rhG-CSF） to mobilize autologous peripheral blood stem cells on neoplastic hematologic patients conceived many times chem otherapy. Methods A retrospective study of autologous peripheral blood stem cells mobilization by Tanshinone combine rhG-CSF or single rhG-CSF from November 2008 to December 2010. Tanshinone combine rhG-CSF with 31 patients,rhG CSF alone with 35 cases,the average age was 40.6 years （18 to 63 years） ;include malignant lymphoma 53 cases,acute myeloid leukemia （AML） 9 ca ses, and acute lymphoblastic leukemia （ALL） 4 cases. Before mobilization,all patients average receiving 5 （3 to 8） cycles of chemo therapy. Mobilization program： malignant lymphoma and ALL were treated with MOED chemotherapy, AML were treated with MA regimen. When the WBC began to rise after get to the minimum,give Tanshinone （40 mL/d） combined rhG-CSF 10 μg/（kg · d） ,or single give rhG-CSF 10 μg/（kg · d）. WBC of all patients decreased to 1.0 × 10^9/L during mobilization, and PLT dropped to 35× 10^9/L. After mobilize four days, peripheral blood mononuclear cells collected,and detect the number of MNC and CD34＇ cells. Autologous peripheral blood stem ceils were infused after 24 -- 36 hours post-regimen. Results In Tanshinone combine rhG-CSF group, the average number of collected MNC number is E8.6× 10^8/kg（6.1-12. 3） × 10^8/kg],and CD34＋ ceils is [5.9 × 10^6/kg （2.5--10.3） × 10^6/kg]. In rhG-CSF group, the average collected MNC number is [7.3 × 10^8/kg（4.4-- 10.9）× 10^8/kg] （P〈0.05 ）, and CD34＋ cells is [4.1 × 10^5/kg（2.0--8.7）× 10^6/kg] （P〈0.05）. After regimen, all hematopoietic stem cell transplant pa tients has obvious bone marrow suppression. In Tanshinone combine rhG CSF group,neutrophil recovery to 0.5× 10^9/L time is ＋ 10.4 （＋8- ＋14）days,and PLT recovery to 20× 10^9/L time is ＋13.8 （＋10- ＋17）days;In rhG-CSF alone group,nentrophil re coveryto0. 5× 10^9 /L time is ＋10.8 （＋8-＋15） days（P〈0. 01） ,and PLT recovery to 20× 10^9/L time is ＋14.2（＋11 ＋19） days（P〉0.01）. Conclusion Tanshinone combine rhG CSF mobilization program can significantly increase the effect of autologous peripheral blood stem cell mobilization and ensure the reconstruction of hematopoietic function after transplantation. For the elderly patients and patients with many times chemotherapy, Tanshinone combine rhG CSF is a safe and effective method of mobilizing hematopoietic stem cells.