G-CSF联合普乐沙福动员异基因造血干细胞移植亲缘健康供者外周血造血干细胞的单中心分析

A Single-Center Analysis of the Use of G-CSF Combined with Plerixafor to Mobilize Peripheral Blood Hematopoietic Stem Cell from Healthy Related Donors in Allogeneic Hematopoietic Stem Cell Transplantation

目的:研究粒细胞集落刺激因子(G-CSF)联合普乐沙福对异基因造血干细胞移植(allo-HSCT)的亲缘健康供者外周血造血干细胞动员的效果及安全性。方法:回顾性分析2019年4月至2021年4月在河北燕达陆道培医院采用G-CSF联合普乐沙福动员方案的亲缘健康供者33例(观察组),应用G-CSF细胞动员d 4采集骨髓,d 5采集外周血造血干细胞(PBSC),d 5晚加用普乐沙福,并于d 6再次采集PBSC。随机选取历史同期采用单独G-CSF方案动员的亲缘健康供者46例作为对照组,分析2组供者d 5和d 6 PBSC采集物中CD34^(+)细胞计数。以调查问卷的方式观察供者普乐沙福给药后的不良反应。分析接受"G-CSF+普乐沙福"动员方案的allo-HSCT患者和仅接受"G-CSF"动员方案的造血干细胞移植患者在移植后100天总a GVHD、Ⅲ-Ⅳ度a GVHD、CMV血症和EBV血症的发生方面的差异。结果:观察组在d 5和d 6 PBSC采集物中CD34^(+)细胞数(M±Q)分别为(1.71±1.02)×10^(6)/kg和(4.23±2.33)×10^(6)/kg,d 6 PBSC采集物中CD34^(+)细胞数明显高于d 5采集的细胞数(P<0.001)。对照组d 5和d 6 PBSC采集物中CD34^(+)细胞数(M±Q)分别为(2.47±1.60)×10^(6)/kg和(1.87±1.37)×10^(6)/kg,d 6 PBSC采集物中CD34^(+)细胞数明显低于d 5采集的细胞数(P<0.001)。应用普乐沙福后的不良反应均为1、2级,停药后症状均自行消失。接受联合动员方案与仅接受G-CSF方案的造血干细胞移植患者移植后100天的总a GVHD、Ⅲ-Ⅳ度a GVHD、CMV血症和EBV血症等方面差异均无统计学意义(P>0.1)。结论:G-CSF联合普乐沙福细胞动员方案应用于allo-HSCT安全有效,加用普乐沙福后可显著提高PBSC采集物中CD34^(+)细胞数量。

Objective:To study the effect and safety of G-CSF combined with Plerixafor on the mobilization of peripheral blood hematopoietic stem cells from healthy related donors of allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:It was analyzed retrospectively that the data of peripheral blood hematopoietic stem cells from 33(observation group) related donors mobilized by G-CSF plus Plerixafor in Hebei Yanda Lu Daopei Hospital from April 2019 to April 2021.Bone marrow and peripheral blood hematopoietic stem cells(PBSCs) of these donors were respectively collected on the fourth and fifth day of G-CSF-induced mobilization.Following the administration of Plerixafor on the night of the fifth day,PBSCs were collected on the sixth day once again.46 donors using "G-CSF only" mobilization method in the same period were randomly selected as the control and respectively analyzed the differences of CD34^(+) cell counts on the fifth and the sixth day in two groups.And the donors’ adverse reaction to Plerixafor in the form of questionnaire was also observed.Then it was compared that the patients who underwent alloHSCT in "G-CSF+Plerixafor" group and "G-CSF only" group in terms of acute GVHD at grade Ⅰ-Ⅳ or Ⅲ-Ⅳ,CMV reactivation and EBV reactivation.Results:CD34^(+) cells count(M±Q) among PBSCs collected on the fifth and the sixth day in the observation group were(1.71±1.02) × 10^(6)/kg and(4.23±2.33) × 10^(6)/kg,respectively.CD34^(+) cell counts on the sixth day was significantly higher than that of the fifth day(P<0.001);While the counterparts in the control group were(2.47±1.60) × 10^(6)/kg and(1.87±1.37) × 10^(6)/kg,respectively.By statistical analysis,CD34^(+) cell counts on the sixth day was significantly less than that of the fifth day(P<0.001).The adverse reaction to Plerixafor for the donors in the study were all grade 1 or 2(mild or moderate) according to CTCAE 5.0 and disappeared in a short time.The patients who underwent allo-HSCT in the "G-CSF+Plerixafor" group and "G-CSF only" group were not statistically significant in terms of acute GVHD at grade Ⅰ-Ⅳ or Ⅲ-Ⅳ,CMV reactivation and EBV reactivation(P>0.1).Conclusion:The cell mobilization program of G-CSF combined with Plerixafor is safe and effective for being applied to allo-HSCT.The addition of Plerixafor can significantly increase the number of CD34 postive cells in the PBSC collection.