预判急性白血病患者Auto-PBSCT动员、采集效果影响因素的临床研究

Clinical analysis of the factors influencing the mobilization and collection of peripheral hematopoietic stem cells in acute leukemia patients

目的：探讨急性白血病患者外周血干细胞动员、采集的效率及影响因素。方法对37例急性白血病患者经化疗＋生长因子动员，动员第5～10天，当外周血WBC＞5×109/L，CD34＋＞20个/μl时，使用CS-3000 Plus血细胞分离机（Baxter公司）进行外周血干细胞采集；采集前外周血WBC分类单个核细胞（MNC，包括幼稚细胞、淋巴细胞及单核细胞），计算MNC%×WBC计数＞（4～6）×109/L预计需要采集循环血容量。分析不同化疗动员时机、疾病、年龄、性别的动员采集，并对采集前外周血进行白细胞计数、分类以及干细胞采集物进行WBC计数、分类和CD34＋检测。结果所有患者均成功动员和采集到了外周血干细胞（MNC＞6×108/kg，CD34＋＞2×106/kg），并成功造血重建。急性髓细胞白血病患者采集所获得的 MNC 与急性淋巴细胞白血病患者采集获得无明显差异；但急性淋巴细胞白血病患者采集获得CD34＋细胞明显较多（P＝0.015）；动员时机的化疗病程与采集物的CD34＋细胞呈负相关，动员时机≤3个疗程与≥6个疗程比较，前者CD34＋细胞明显较好，具有统计学差异（P＝0.028）；外周血MNC数值与采集物MNC及CD34＋细胞具有相关性（r＝0.600，P＝0.00；r＝0.510，P＝0.001）。结论根据不同的疾病、性别、年龄，采用不同的动员采集方案，一般可以成功采集。外周血 MNC 数值对采集物中 CD34＋细胞的总量具有一定预测意义。

ObjectiveTo investigate the factors influencing the efficiency of mobilization and collection of peripheral hematopoietic stem cells in acute leukemia patients.MethodsAfter mobilization with granulocyte colony stimulating factor （G-CSF） or with combination of G-CSF and chemotheraphy for patients of acute leukemia patients, the peripheral blood hematopoietic stem cells were collected by CS 3000 PLUS blood cell separator. The effect of different diseases, ways of mobilization, age, and sex on the mobilization and collection was analyzed. We did WBC count, morphological classification and CD34＋ detection about the peripheral blood stem cell and the peripheral blood before collected the stem cells.ResultsThe collection was successful with all cases, with MNC〉6×108/kg, and CD34＋〉2×106/kg. Compared to AML and ALL, the collected MNC were got no obvious difference. But acute lymphocytic leukemia patients collected more CD34＋cells; It had a significant differences （P=0.015）. Mobilization of the time point about the number of chemotherapy and acquisition of CD34＋ cells was negatively correlated（P=0.028）. There were certain relation between the Lymphocyte numerical and the MNC, CD34＋cells in PBSC. They had positive correlation.ConclusionIt can successfully collect peripheral hematopoietic stem cells with different protocol according to different diseases, sex and age. To collected in the amount of CD34＋cells, peripheral blood lymphocytes of quantity has certain prediction significance.