供者应用粒细胞集落刺激因子促进异基因骨髓移植受者造血重建的临床研究

The clinical study on accelerating hemopoietic reconstitution of allo bone marrow transplantation recipients by using G CSF in donors

目的 评价供者应用粒细胞集落刺激因子 (G CSF)以增加骨髓中CD34+细胞的效果和对异基因骨髓移植造血重建的影响。方法 供者采髓前应用G CSF 2 5 0 μg/d ,连用 7d ,随后对 15例白血病患者进行异基因骨髓移植 ,观察植入物单个核细胞、CD3+细胞、CD34+细胞和粒 单核系祖细胞 (CFU GM)的变化及移植后造血恢复情况 ,并对 5名供者应用G CSF前后CD34+细胞变化和 3例G CSF作用后造血祖细胞改变进行测定。结果 15例骨髓移植后白细胞达 1.0× 10 9/L的时间是(16 .1± 3 .1)d ,血小板达 2 0× 10 9/L的时间为 (18.4± 4.0 )d ,对照组为 (2 6 .2± 6 .6 )d和 (2 8.1±7.1)d(P <0 .0 1) ;植入物中CD34+细胞和CFU GM明显增加 ,与对照组比较 ,P <0 .0 1;G CSF作用前后CD34+细胞均增加 ,CFU GM和巨核细胞集落形成单位 (CFU MK)增殖旺盛 ,且CFU GM增殖程度超过CFU MK。结论 异基因骨髓移植供者应用G CSF具有促进造血恢复作用 ,G CSF作用后增加移植物中CD34+细胞和CFU GM数量 ,促造血祖细胞增殖 ,这可能是该方法造血恢复快的原因之一。

Objective To investigate the effects of donor administered G CSF in accelerating CD34 + cells in bone marrow and on hemopoietic reconstruction in allo bone marrow transplantation (BMT). Methods Fifteen consecutive patients with leukemia who underwent allo BMT infused marrow stimulated with G CSF 250?μg/d for 7 days. The changes in the number of mononuclear cells, CD3 + cells, CD34 + cells and CFU GM infused marrow cells in the grafts and hemopoietic recovery after BMT were estimated. The changes of CD34 + cells before and after administration of G CSF in 15 donors and the changes in hematopoetic progenitor cells after treatment with G CSF in 3 donors were determined. Results Hematopoietic reconstruction after allo BMT in 15 patients were accelerated. The days of leukocyte count exceeding 1.0 ×10 9/L and platelet count exceeding 20×10 9/L were ( 16.1 ± 3.1 )days and ( 18.4 ± 4.0 )days respectively ( 26.2 ± 6.6 and 28.1 ± 7.1 days respectively in the control group, P < 0.01 ). CD34 + cells and CFU GM in the grafts were obviously increased as compared with those in the control group ( P < 0.01 ). CD34 + cells were increased both before and after stimulation of G CSF, CFU GM and CFU MK were vigorously proliferated, especially the proliferation of CFU GM. Conclusions CD34 + enriched marrow cells infused with G CSF stimulating donor BM might be a reliable indicator of accelerating hemato poietic recovery. The elevation in number of CFU MK was associated with accelerated platelet recovery.