重组人粒细胞集落刺激因子动员的供者外周血采集物治疗异基因造血干细胞移植后植入功能不良的疗效和安全性

The efficacy and safety of recombinant human granulocyte colony stimulating factor primed donor peripheral call harvest in treatment of poor graft function after allogeneic stem cell transplantation

目的探讨重组人粒细胞集落刺激因子（rhG—CSF）动员的供者外周血造血干细胞（PBSC）治疗异基因造血干细胞移植术后植入功能不良（PGF）的安全性及有效性。方法对2003年1月至2012年11月期间诊断PGF并接受PBSC治疗的患者进行回顾性分析，观察输注后30d血液学反应及回输后发生移植物抗宿主病（GVHD）的情况。结果28例PGF患者接受了PBSC治疗，其中男21例，女7例。中位年龄28（12～50）岁。16例为原发性PGF，12例为继发性PGF。回输的单个核细胞（MNC）中位数为2．0（1．0～5．8）×10／kg，随访至回输后6个月。28例患者中，12例（42．9％）在回输后30d获得血液学反应，总体有效率为53．6％（15／28）。回输后发生GVHD8例（28．6％）。最终存活16例（57．1％）。患者年龄（≤28岁／〉28岁）、性别、供者类型（同胞相合／亲缘不相合）、PBSC前是否接受预处理、初始中性粒细胞植活时间（≤18d／〉18d）、PBSC植活时间（≤100d／〉100d）及回输MNC数（≤2．0×108／kg／〉2．0×108／kg）对血细胞恢复没有影响。原发性PGF的30d有效率（4／16）明显低于继发性PGF（8／12）（P=0．022）。结论rhG-CSF动员的PBSC治疗可作为继发性PGF的一种治疗方案，但对于原发性PGF疗效欠佳。

Objective To assess the efficacy and safety of recombinant human granulocyte colony stimulating factor （rhG-CSF） primed donor peripheral blood stem cell （PBSC） on the treatment of poor graft function （PGF） after allogeneic stem cell transplantation （allo-HSCT）. Methods The patients diagnosed as PGF after allo-HSCT and transfused with rhG-CSF primed PBSC from January 2003 to November 2012 were retrospectively analyzed. Hematological response was assessed at day 30 after transfusion. Graft versus host disease （GVHD） was assessed until 6 months after transfusion. Results There were 28 patients including 21 men and 7 women with a median age of 28 （ 12-50 ） years old. Of these patients, 16 were diagnosed as primary PGF. The median number of transfused mononuelear cells was 2. 0 （ 1.0-5.8 ） x 108/kg. Totally 42. 9% （ 12/28 ） patients achieved good response. Eight patients （ 28.6% ） developed GVHD. Sixteen patients （57.1% ） survived. Age （ ~〈/〉 28 years） , gender, donor type （ matched sibling/ mismatched related ） , additional conditioning regimen prior to transfusion, time of neutrophil engraftment （ ~〈/〉 18 days） time of transfusion （ ~〈/〉 100 days after allo-HSCT） and number of mononuelear cells （~〈/〉 2. 0 x 10S/kg） did not impact hematological response. However, response rate of primary PGF （4/16） was significantly lower than that of secondary PGF （8/12） （P = 0. 022）. Conclusion Transfusion of PBSC mobilized by rhG-CSF could be considered as an option to treat secondary PGF after allogeneic stem cell transplantation.