自体外周血干细胞动员和采集的研究

Study of Auto-peripheral Blood Stem Cell Mobilization and Collection

目的 探索理想的血液肿瘤外周血干细胞动员方案。方法 选择 15例恶性血液病患者 ,14例应用米托蒽醌 (2 0mg/m2 ) +阿糖胞苷 (8g/m2 ) +粒细胞集落刺激因子 (G -CSF ,惠尔血 30 0 μg/d ,从白细胞 <1× 10 9/L开始至采集完成 ) (MAG) ;1例多发性骨髓瘤应用环磷酰胺 (4 g/m2 ) +G -CSF(CG)。用CS - 30 0 0Plus血细胞分离机采集单个核细胞。处理血量约 2 0 0ml/kg ,历时 3～ 4h。直至CD34+细胞数 >4× 10 6/kg为止。 结果 14例用MAG方案者中 ,一次采集即采到CD34+细胞 2× 10 6/kg以上者 11例 (79% ) ,其中 9例 (6 4% ,9/14)达 4× 10 6/kg以上。通过测定采集日外周血中CD34+细胞数可预测一次采集足量干细胞的可能性 (P <0 .0 0 1)。 2例部分缓解者动员后获完全缓解 ,1例Ph阳性小克隆和 1例AML1/ETO基因在动员后转阴。移植 14例可评价者中 10例存活至今 (3～ 5年 ) ,4例 (Ph+杂白、L2和L3型急淋、急单各 1例 )复发死亡。结论 MAG具有抗瘤和动员双重作用。

Objective To explore optimal peripheral blood stem cell (PBSC) mobilization protocol for hematopoietic malignancies. Methods Fifteen patients were included.The combination of mitoxantrone (20mg/m 2) and cytosine arabinoside (8g/m 2) plus filgrastim(rhG-CSF,300μg/d,from the day WBC<1.0×10 9/L until completion of leukapheresis) (MAG) was used for mobilization of PBSCs in 14 cases with acute leukemia and lymphoma. One patient with myeloma received cyclophosphamide (4g/m 2) plus rhG-CSF(300μg/d) (CG). Leukapheresis was performed daily by using a fenwal CS-3000 plus (Baxter,Deerfield,IL) to process 200ml of whole blood/kg for 3 to 4 hours until analysis of the product confirmed that cares CD34 + cells greater than 4×10 6/kg of patient weight in the collected blood. Results By using MAG regimen 2×10 6/kg and 4×10 6/kg CD34 + cells could be obtained through a single leukapheresis in 79%(11/14) and 64%(9/14) of patients respectively. The CD34 + cells circulating concentration on harvesting day correlated significantly with the number of CD34 + cells per kilogram collected in leukaphresis ( P <0.001).Two patients in partial remission before mobilization achieved complete remission. The Ph chromosome in a HAL and AML1/ETO fusion gene product in a AML-M 2 became negative after mobilization. Fourteen evaluable cases after autotransplants were followed up. Ten of them survived. The median of survival time was 4 years(3～5 years).Four patients (1 Ph +HAL,1 L 3,1 L 2,1 M 5b ) died of relapse. Conclusion MAG is an efficient regimen for consolidation therapy and mobilization. If peripheral-blood circulating CD34 + concentration is over to 25×10 6/L, CD34 + cells more than 2×10 6/kg can be collected by a single leukapheresis.