Hester J
Haemaferesis Consultants, University of Texas, Houston, TX, USA.
Transfus Sci. 2000 Oct;23(2):125-32. doi: 10.1016/s0955-3886(00)00077-1.
Centrifugal technology, continuous flow and discontinuous flow, has served as the technology platform for extracting cell concentrates of interest from peripheral blood (PB) for patient therapy for the past 35-40 yr. Models for procedure outcome exist for collection of normal donor (ND) platelet and granulocyte concentrates that integrate: (1) biological variables (pre-procedure PB cell concentration, the total circulating quantity of cells, donor/patient blood volume (BV)), (2) device efficiency, and (3) procedure parameters such as total blood processed (TBP), and in the case of cytoreductions - the volume collected. (cf. Hester J, Kellogg R, Mulzet A, et al., Blood (54) (1979) 254; Hester J, Ventura G, J Clin Apheresis (4) (1988) 188.) To date, no predictive CD34+ yield algorithm integrating these three variables has been formulated that could be applied prospectively for individual ND or patients (PT). There are economic, toxicity and statistical comparison benefits to be derived from generating such an algorithm.A small pilot study is presented with a brief review of current publications that suggest the circulating quantity of CD34+ cells available to be collected and the quantity mobilized during leukapheresis are the major contributing factors to CD34+ yield, somewhat obscuring the role of the total blood processed (TBP). Intraprocedure CD34+ cell mobilization, incompletely characterized to date, appears to be a dynamic nonlinear process, as the harvested yield does not rise proportionally as the fraction of BV processed increases. And, like the pre-procedure PB CD34+ concentration and total circulating quantity, CD34+ mobilization during leukapheresis probably relates to prior treatment and the priming regimen. Studies that provide: (1) separate analyses of PT populations divided according to chemotherapy toxicity factors; (2) design and implementation of optimal priming regimens with respect to dose 'intensity' of both growth factors and chemotherapy; and (3) standardization of laboratory assays of CD34+ enumeration seem essential to generating a predictive algorithm.
在过去35至40年中，离心技术（包括连续流和间断流）一直是从外周血（PB）中提取用于患者治疗的目标细胞浓缩物的技术平台。对于正常供体（ND）血小板和粒细胞浓缩物的采集，存在整合以下因素的程序结果模型：（1）生物学变量（术前PB细胞浓度、细胞的总循环量、供体/患者血容量（BV）），（2）设备效率，以及（3）程序参数，如总处理血量（TBP），对于细胞去除术而言——采集的体积。（参见Hester J、Kellogg R、Mulzet A等人，《血液》（54）（1979年）254页；Hester J、Ventura G，《临床血液成分分离杂志》（4）（1988年）188页。）迄今为止，尚未制定出一种整合这三个变量的预测性CD34+产量算法，可前瞻性地应用于个体ND或患者（PT）。生成这样一种算法可带来经济、毒性和统计比较方面的益处。本文介绍了一项小型试点研究，并简要回顾当前的出版物，这些研究表明，可采集的CD34+细胞的循环量以及白细胞单采过程中动员的量是CD34+产量的主要影响因素，这在一定程度上掩盖了总处理血量（TBP）的作用。术中CD34+细胞动员目前尚未完全明确其特征，似乎是一个动态非线性过程，因为收获产量并不随处理的BV比例增加而成比例上升。而且，与术前PB CD34+浓度和总循环量一样，白细胞单采过程中的CD34+动员可能与先前的治疗和启动方案有关。提供以下内容的研究似乎对于生成预测算法至关重要：（1）根据化疗毒性因素对PT群体进行单独分析；（2）针对生长因子和化疗的剂量“强度”设计并实施最佳启动方案；（3）CD34+计数实验室检测的标准化。
