摘要
目的:探讨COAEP化疗方案联合粒细胞集落刺激因子(G-CSF)治疗对血液病患者外周血干细胞(PBSC)动员的效果。方法:选择恶性血液病患者24例,其中非霍奇金淋巴瘤(NHL)15例,多发性骨髓瘤(MM)6例,霍奇金病(HD)3例。以COAEP方案动员[d1(第1天):环磷酰胺(CTX)400 mg/m^2,长春地辛(VDS)2 mg/m^2;d1～5应用阿糖胞苷(Ara-C)60 mg/m^2,依托泊甙(VP-16)60 mg/m^2,泼尼松(Pred)30 mg/m^2]。将患者随机分为试验组和对照组。试验组取患者化疗后自细胞抑制达最低点开始稳定回升(第二次回升)时为节点,予G-CSF(惠尔血)300μg/d;而对照组以动员方案结束后白细胞跌至低谷首次回升时即使用G-CSF 300μg/d。2组患者开始使用G-CSF后每日查血常规,当白细胞计数>10.0×10~9/L和单个核细胞(MNC)计数>1.0×10~9/L时使用COBE血细胞分离机,以自动单个核细胞分离程序采集PBSC。结果:使用COAEP方案动员后,24例恶性血液病患者平均获得的CD34+细胞数达每例17.25×10~6/kg。试验组患者平均使用G-CSF的时间为4.17 d,采集PBSC次数为1～2次,采集液CD34+细胞数为每例11.73×10~6/kg(几何均值);对照组患者平均使用G-CSF的时间为5.92 d,采集PBSC次数为1～2次,采集液CD34+细胞数为每例1.79×10~6/kg(几何均值),2组间差异有统计学意义(P<0.0028)。结论:COAEP联合化疗可作为血液病患者自体PBSC动员的方案,并能获得良好的干细胞产率。患者白细胞开始稳定回升时使用G-CSF,可显著提高PBSC产率。根据患者外周血白细胞计数及单个核细胞数决定PBSC采集时机有效可行,值得临床推广。
Objective To investigate the effect of COAEP plus G-CSF on the mobilization of peripheral blood stem cells in bematologieal disease patients. Methods Twenty-four malignant hematological disease patients were enrolled, including 15 cases of non-Hodgkin＇s lymphoma, 6 cases of multiple myeloma and 3 cases of Hodgkin＇s disease. Mobilization chemotherapy regimen was COAEP： cyclophosphamide 400 mghn2, vindesine 2 mg/m^2, cytosine arabinoside 60 mg/m^2×5 d, etoposide 60 mg/m^2×5 d, and prednisone 30 mg/m^2×5 d. Patients were randomly assigned into experimental group and control group according to the time point of giving G-CSF. In experimental group, G-CSF 300 μg/d was given when the number of WBC began to increase stably （second rebound） after rebounding. G-CSF 300 μg/d was given in control group when the WBC started to rebound after reaching the nadir. The routine blood cell count was checked daily after giving G-CSF, and CD34＋ blood cell was collected by apheresis when peripheral WBC〉10.0×10^9/L, MNC〉1.0×10^9/L and immature cells emerged in peripheral WBC. Leukapheresis was performed with COBE blood cell separator using separate MNC process. Results By using the COAEP regimen, an average of 17.25×10^6/kg CD34＋ cell was collected. The experimental group used G-CSF for 4.67 days and had 11.73×10^6/kg （geomean） CD34＋ cell collected in 1-2 collections： the control group used G-CSF for 5.92 days and had 1.79×10^6/kg （geomean） CD34＋ cell collected in 1-2 collections. The difference between the two groups was statistically significant （P〈0.0028）. Conclusions COAEP was effective as a mobilizing regimen for stem cell collection. Giving G-CSF when WBC began to increase stably （second rebound） could elevate the CD34＋ cell yield significantly. Determining the time of harvesting stem cells by the account ofperipheral blood WBC and MNC is feasible and could be used in practice.
出处
《诊断学理论与实践》
2008年第5期535-539,共5页
Journal of Diagnostics Concepts & Practice
关键词
自体外周血干细胞移植
动员方案
采集
粒细胞集落刺激因子
Autoallergic peripheral blood stem cell transplantation
Mobilizing regimens
Collection
Granulocyte-colony stimulating factor
