长短效粒细胞集落刺激因子联合应用提高自体外周血造血干细胞采集优良率

The combined application of long-and short-acting granulocyte colony-stimulating factor improved the excellent rate of autologous peripheral blood hematopoietic stem cell collection

目的:比较长短效粒细胞集落刺激因子(G-CSF)联合[聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)+G-CSF]、化疗联合短效G-CSF以及单用短效G-CSF动员方案在患者自体外周血造血干细胞动员、采集及移植后造血重建中的差异,以期获得更有效的动员方案。方法:收集2019年2月—2022年2月我院血液科71例恶性血液系统疾病行自体外周血造血干细胞移植患者的临床数据进行前瞻性研究。将长短效G-CSF联合(PEG-rhG-CSF+G-CSF组,12例)、化疗联合短效G-CSF(化疗+G-CSF组,34例)以及单用短效G-CSF(单用G-CSF组,25例)3种动员方案对采集细胞数、成功率、移植后造血重建时间结果进行比较,并对影响动员疗效的因素进行统计分析。结果:3组在采集CD34^(+)细胞数、采集优良率、造血重建时间方面比较差异有统计学意义(P<0.05)。PEG-rhG-CSF+G-CSF组采集CD34^(+)细胞数[(15.77±5.44)×10^(6)/kg vs(4.30±0.59)×10^(6)/kg,P=0.001]、采集优良率(100.0%vs 32.0%,P=0.001)显著优于单用G-CSF组,且PEG-rhG-CSF+G-CSF组采集CD34^(+)细胞数[(15.77±5.44)×10^(6)/kg vs(8.34±0.94)×10^(6)/kg,P=0.034]、采集优良率(100.0%vs 73.5%,P=0.049)明显优于化疗+G-CSF组。在造血重建方面,PEG-rhG-CSF+G-CSF组粒细胞恢复时间[(10.25±0.78)d vs(12.56±0.69)d,P=0.042]及血小板恢复时间[(10.42±0.41)d vs(12.68±0.70)d,P=0.035]明显优于单用G-CSF组,且PEG-rhG-CSF+G-CSF组粒细胞恢复时间[(10.25±0.78)d vs(13.68±0.42)d,P=0.001]及血小板恢复时间[(10.42±0.41)d vs(13.15±0.41)d,P=0.007]明显优于化疗+G-CSF组。3组间采集成功率比较差异无统计学意义(P>0.05)。所有患者移植后均顺利获得造血重建,无移植相关死亡。结论:长短效G-CSF联合动员方案与化疗+G-CSF及单用G-CSF动员方案相比,CD34^(+)细胞采集数及采集优良率更高,造血重建时间明显缩短,该动员方案可作为恶性血液系统疾病患者自体外周血动员的一项较好选择。

Objective To compare the differences in mobilization,collection,and post-transplant hematopoietic reconstitution of autologous peripheral blood hematopoietic stem cells among the long-and short-acting granulocyte colony-stimulating factor(G-CSF)combined regimen(pegylated recombinant human granulocyte colony-stimulating factor[PEG-rhG-CSF]+G-CSF),chemotherapy combined with short-acting G-CSF and short-acting G-CSF alone,and figure out which one is more effective.Methods The clinical data of 71 patients underwent peripheral blood hematopoietic stem cell transplantation from February 2019 to February 2022 were collected.The results of number of collected cells,success rate and time to hematopoietic reconstruction after transplantation were compared,including long-and short-term G-CSF combined regimen(PEG-rhG-CSF+G-CSF group,n=12),chemotherapy combined with short-term G-CSF(chemotherapy+G-CSF group,n=34),and short-term G-CSF alone(G-CSF group,n=25),and the factors affecting the efficacy of mobilization were analyzed.Results There were significant differences in the number of CD34^(+)cells,excellent rate of collection,and hematopoietic reconstruction time among the three groups(P<0.05).The number of CD34^(+)cells collected([15.77±5.44]×10^(6)/kg vs[4.30±0.59]×10^(6)/kg,P=0.001)and the excellent rate(100.0%vs 32.0%,P=0.001)in the PEG-rhG-CSF+G-CSF group were significantly better than those in the G-CSF group,and the number of CD34^(+)cells collected([15.77±5.44]×10^(6)/kg vs[8.34±0.94]×10^(6)/kg,P=0.034)and the excellent rate(100.0%vs 73.5%,P=0.049)in the PEG-rhG-CSF+G-CSF group were better than those in the chemotherapy+G-CSF group.In terms of hematopoietic reconstruction,the granulocyte recovery time([10.25±0.78]d vs[12.56±0.69]d,P=0.042)and the platelet recovery time([10.42±0.41]d vs[12.68±0.70]d,P=0.035)in the PEG-rhG-CSF+G-CSF group were better than those in the G-CSF group,and the granulocyte recovery time([10.25±0.78]d vs[13.68±0.42]d,P=0.001)and platelet recovery time([10.42±0.41]d vs[13.15±0.41]d,P=0.007)in the PEG-rhG-CSF+G-CSF group were better than those in the chemotherapy+G-CSF group.There was no significant difference in acquisition success rate among the three groups(P>0.05).All patients successfully achieved hematopoietic reconstruction after transplantation,and no transplant-related death occurred.Conclusion Compared with chemotherapy+G-CSF and G-CSF mobilization alone,the long-and short-acting G-CSF combined mobilization regimen has higher CD34^(+)cell collection number and good rate of collection,and significantly shortens the time of hematopoietic reconstruction.This mobilization regimen can be a good option for autologous peripheral blood mobilization in patients with malignant hematological diseases.