恶性血液病病人自体外周血造血干细胞动员采集影响因素分析

Analysis of the influencing factors of mobilization and collection of autologous hematopathy in patient with malignant blood disease

目的:探讨不同动员方案以及年龄、化疗疗程、疾病缓解状态等因素对自体外周血干细胞采集动员效果的影响。方法:回顾性分析31例急性白血病、恶性淋巴瘤及多发性骨髓病人病历资料。分别行直接G-CSF动员方案(G-CSF组)及大剂量VP-16+G-CSF动员方案(VP-16组)、CTX+G-CSF动员方案(CTX组),对比不同动员方案中采集细胞数量、血液学指标变化、不良反应等,分析年龄、性别、疾病状态、化疗疗程、治疗至动员时间等因素分析对干细胞采集影响。结果:31人共采集59次,获得单个核细胞(5.7±1.6)×10^8/kg,CD34+细胞(2.1±0.7)×10^6/kg。G-CSF组动员至采集中位时间4 d,但CD34+细胞产量低于其他2组(P<0.05),VP-16组与CTX组采集CD34+细胞数量差异无统计学意义(P>0.05),VP-16组与CTX组动员至采集中位时间均为12 d。CTX组采集时血小板水平低于VP-16组(P<0.05)。VP-16组出现化疗后粒细胞缺乏并发热(>38℃)5例,CTX组出现3例。采集的CD34+细胞数男性病人高于女性,≤55岁病人高于>55岁,≤8个化疗疗程病人高于>8个化疗疗程病人,优于部分缓解病人高于部分缓解病人,差异均有统计学意义(P<0.05)。结论:化疗联合G-CSF方案可以动员出更多CD34+细胞数,大剂量VP-16+G-CSF动员方案采集时血小板水平更高,采集安全性更有保障。男性、年龄≤55岁、化疗疗程≤8个疗程时采集成功率更高。

Objective:To explore the effects of various mobilization schemes,age,chemotherapy cycle,disease state and other factors on the autologous peripheral blood stem cell mobilization and collection.Methods:The clinical data of 31 patients with acute leukemia(AL),Non-Hodgkin′s lymphoma(NHL)and multiple myeloma(MM)were retrospectively analyzed.The patients with Granulocyte Colony-Stimulating Factor(G-CSF)mobilization scheme,large dose VP-16(Etoposide)combined with G-CSF mobilization scheme and Cyclophosphamide(CTX)combined with G-CSF mobilization scheme were divdied into the the G-CSF group,VP-16 group and CTX group,respectively.The number of cells,changes of hematological indexes and adverse reactions among three groups were compared.The effects of age,gender,disease status,chemotherapy cycle,treatment to mobilization time on stem cell collection were analyzed.Results:A total of 59 times were collected from 31 people,and the(5.7±1.6)×10^8/kg mononuclear cells and(2.1±0.7)×10^6/kg CD34+cells were obtained.The number of median day from mobilizating to collecting in G-CSF group was 4 days,but the CD34+cell production in G-CSF group was lower than that in other two groups(P<0.05).There was no statistical significance in the number of CD34+cells between the VP-16 group and CTX group(P>0.05),and the number of median day from mobilizating to collecting in VP-16 group and CTX group were 12 days.The platelet level in CTX group was lower than that in VP-16 group(P<0.05).Five cases with ranulocytopenia complicaed with fever(>38℃)in VP-17 group were found after chemotherapy,while 3 patients in the CTX group were identified.The number of CD34+cells collection in male patients was higher than that in female patients,which in patients with≤55 years old was higher than that in patients with>55 years old,which in patients with≤8 chemotherapy courses was higher than that in patients with>8 chemotherapy courses,and which in CR patients was better than that in PR patients(P<0.05).Conclusions:Chemotherapy combined with G-CSF can mobilize more CD34+cells,and the platelet level in the high-dose VP-16+G-CSF Mobilization scheme is higher,and the safety of collection is more guaranteed.The success rates in male,age≤55 years old and course of chemotherapy≤8 courses patients are higher.