61例淋巴瘤患者自体外周血造血干细胞动员方案临床分析

Clinical analysis of autologous peripheral blood hematopoietic stem cell mobilization regimen in 61 lymphoma patients

目的:比较化疗+G-CSF与化疗+G-CSF+GM-CSF方案对淋巴瘤患者外周血造血干细胞动员采集及造血重建的效果差异。方法:回顾性分析2008年5月至2016年10月天津医科大学肿瘤医院血液科收治的61例行自体外周血造血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)的淋巴瘤患者,分别采用化疗+G-CSF或化疗+G-CSF+GM-CSF方案动员外周血造血干细胞的临床资料。分析动员采集效果及移植后造血重建、发热、抗生素应用等情况。结果:动员期间所有患者白细胞计数均降至1.0×109/L以下,血小板计数降至40×109/L以下。化疗+G-CSF组患者采集CD34+细胞数的成功率明显低于化疗+G-CSF+GM-CSF组(52.5%vs.90.5%,P=0.003)。所有患者移植后均顺利完成造血重建,无移植相关死亡。化疗+G-CSF组和化疗+G-CSF+GM-CSF组中性粒细胞、血小板恢复时间及回输后发热、抗生素使用情况差异均无统计学意义(P>0.05)。结论:化疗+G-CSF+GM-CSF组动员CD34+细胞产率虽然明显高于化疗+G-CSF组,然而移植成功率、中性粒细胞恢复时间、血小板恢复时间及不良反应均无显著性差异,本研究认为化疗+G-CSF+GM-CSF动员方案并未优于化疗+G-CSF动员方案。

Objective： To compare the efficacy between chemotherapy with granulocyte colony-stimulating factor （G-CSF） and chemotherapy with G-CSF and granulocyte-macrophage colony-stimulating factor （GM-CSF） for the mobilization of peripheral blood hematopoietic stem cells and hematological recovery post-transplantation in patients with malignant lymphoma. Methods： Autologous peripheral blood hematopoietic stem cell mobilization data of 61 malignant lymphoma patients who were treated with chemotherapy plus G-CSF or chemotherapy plus G-CSF and GM-CSF from May 2008 to October 2016 were included in this study. The mobilization efficacy and hematopoietic recovery were analyzed. Results： During mobilization, White blood cells （WBC） of all patients decreased to 1.0×10^9/L and platelets （PLT） dropped to 40×10^9/L. The successful mobilization rates of CD34^＋ cell are 52.5% in chemotherapy plus G- CSF group and 90.5% in chemotherapy plus G-CSF＋GM-CSF group （P=0.003）. All patients successfully underwent hematopoietic reconstruction without transplantation- related mortality. Conclusion： Although chemotherapy with G- CSF ＋ GM- CSF can significantly increase the effect of autologous peripheral blood hematopoietic stem cell mobilization, the reconstruction of hematopoietic function after transplantation and side reaction between the two groups are the same. Thus, chemotherapy with G-CSF＋GM-CSF is not superior to chemotherapy with G-CSF in mobilizing autologous peripheral blood hematopoietic stem cells.