外周血CD34^(+)细胞计数对造血干细胞动员和采集临床意义的研究进展

Research progress on clinical significance of peripheral blood CD34^(+) cells count in autologous stem cell mobilization and collection

自体造血干细胞移植(auto-HSCT)被广泛应用于血液系统疾病的临床治疗, 但仍有部分患者面临治疗失败。人体外周血中造血干细胞(HSC)含量极少, 必须通过动员才能促使HSC从骨髓释放到外周血。HSC动员是auto-HSCT的关键过程, 其动员效率和采集量对auto-HSCT成功, 以及移植后转归均有重大影响。由于动员能力差导致的外周血CD34^(+)细胞计数低是auto-HSCT失败的主要原因之一。auto-HSCT中回输HSC数量不足, 可能影响患者的长期预后。在采集前使用新型HSC动员剂普乐沙福抢先治疗, 可有效降低HSC动员失败率。笔者拟就auto-HSCT现状、HSC动员现状、外周血CD34^(+)细胞计数在HSC采集中的作用进行综述, 旨在为临床中外周血HSC动员不佳患者的识别和指导合理的普乐沙福抢先干预提供理论依据。

Autologous hematopoietic stem cell transplantation(auto-HSCT)is widely used in clinical treatment of blood system diseases,but some patients still face treatment failure.The content of hematopoietic stem cells(HSC)in peripheral blood is negligible,and it must be mobilized to promote the release of HSC from bone marrow into peripheral blood.HSC mobilization is a key process of auto-HSCT,and the mobilization efficiency and collection volume have significant impacts on auto-HSCT success and post-transplant outcomes.Low peripheral blood CD34^(+)cell counts due to poor mobilization capacity are one of the main reasons for auto-HSCT failure.The insufficient number of reinfused HSC in auto-HSCT may affect the long-term prognosis of patients.The low count of peripheral blood CD34^(+)cells count due to poor mobilizers is the principal cause for auto-HSCT failure.Preemptive treatment with new HSC mobilization agent plerixafor before collection can effectively reduce the mobilization failure rate.This article intends to review application status of auto-HSCT,the status of HSC mobilization,and role of peripheral blood CD34^(+)count in HSC collection,in order to provide a theoretical basis for identifying patients with poor mobilization in clinical practice and guiding reasonable preemptive intervention with plerixafor.