供者使用粒系集落刺激因子后供髓对异基因骨髓移植受者的影响

Effect of donor marrow stimulated with lenograstim on hemotopoietic reconsititution and GVHD incidence in the patients with Allo BMT

目的 观察供者使用粒系集落刺激因子 (G CSF)后供髓对异基因骨髓移植受者造血重建及移植物抗宿主病 (GVHD)发生的影响。方法 用HLA相合 ,混合淋巴细胞培养 (MLC)阴性的供者骨髓 ,给受者行异基因骨髓移植 ,在预处理方案、GVHD的预防及支持治疗方法相同的条件下 ,比较研究组 30例供者应用G CSF 3～ 4μg·kg-1·d-1,连用 7d后采髓和对照组 15例供者常规采髓对受者异基因骨髓移植造血重建和GVHD发生的作用。结果 在类同采髓量中研究组所获单核细胞(MNC)、粒细胞巨噬细胞集落生成单位 (CFU GM )及CD34数显著大于对照组 (P <0 .0 1)。研究组受者移植后中性粒细胞计数 >0 .5× 10 9/L与血小板 >2 0× 10 9/L时间分别为 (16 .7± 3.2 )d与 (18.4± 3.0 )d ,对照组为 (2 2 .5± 5 .1)d与 (2 6 .3± 5 .90 )d ,P <0 .0 1,研究组造血重建加速。研究组受者急性Ⅱ Ⅳ度GVHD发生 1例 (发生率 3 .3% ) ,对照组发生率 2 6 .7% (P <0 .0 5 )。慢性GVHD两组差异无显著性 (P >0 .0 5 )。输入的T淋巴细胞总数无明显改变 ,通过比较 ,研究组受者CD4减少 ,CD8增加 (P <0 .0 1)。结论 HLA相合的异基因骨髓移植 ,使用经G CSF动员的供者骨髓 ,可使受者造血重建加快 ,尤其减轻重度急性GVHD 。

Objectives In order to investigate the influence of donor marrow stimulated with lenograstim (G CSF) on hemotopoietic reconstitution and incidence of GVHD in the patients undergoing allogeneic bone marrow transplantation (Allo BMT). Methods Forty five leukemia patients as recipients underwent Allo BMT with the bone marrow from the donors with matching HLA and negative mixed lymphocyte culture reaction. The 30 donors (experimental group) were given G CSF 3 4?μg·kg -1 ·day -1 for 7 days prior to marrow harvest. And 15 donors as control group did not receive G CSF. The effects of G CSF on hemotopoietic reconstitution and incidence of GVHD following Allo BMT were compared between the two groups. Results In the equal volume of bone marrow harvested, the number of mononuclear cells, CFU GM and CD34 cells in the experimental group were higher than in the control group ( P < 0.01 ). In the experimental group, the time of granulocyte count exceeding 0.5 ×10 9/L and plalete count exceeding 20×10 9/L was ( 16.7 ± 3.2 )days and ( 18.4 ± 3.0 )days respectively, significantly shorter than in the control group ( 22.5 ± 5.1 )days and ( 26.3 ± 5.9 )days, respectively) ( P < 0.01 ). The incidence of grade Ⅱ Ⅳ aGVHD were 3.3% in the experimental group, significantly lower than in control group ( 26.7% , P < 0.05 ). There was no obvious change in the total number of infused T lymphocyte subsets. In the experimental group CD4 was decreased and CD8 increased markedly as compared with control group ( P < 0.01 ). Conclusions The donor bone marrow stimulated with G CSF could significantly accelerate the hemotopoietic reconstitution, especially alleviate aGVHD during Allo BMT, which might be related with the change in T lymphocytic subpopulation in bone marrow.