使用来格司亭刺激的骨髓细胞进行异基因骨髓移植时，严重急性移植物抗宿主病的发生率较低且造血重建加速。

Low incidence of severe aGVHD and accelerating hemopoietic reconstitution in allo-BMT using lenograstim stimulated BM cells.

作者信息

Ji S, Chen H, Wang H, Ma J, Pan S, Xue M, Zhu L, Liu J, Xiao M, Zhou L

机构信息

Research Centre for Hematology, General Air Force Hospital of PLA, Beijing 100036, China.

出版信息

Chin Med J (Engl). 2001 Feb;114(2):191-5.

PMID:11780205

Abstract

OBJECTIVES

To investigate the efficacy of accelerating hemopoietic reconstraction and reducing a graft versus host disease (GVHD) in Allo-BMT receiving lenograstim stimulated donor marrow and to assess the preliminary biological mechanism.

METHODS

The donors for thirty patients (study group) with leukemia were given lenograstim 3-4 micrograms.kg-1.d-1 for seven days prior to marrow harvest. The results of subsequent engraftment in the recipients was compared with fifteen donors without G-CSF (control group). Five donors themselves were studied to assess the effects of lenograstion on hematopoietic progenitor cells and lymphocyte subsets in BM.

RESULTS

The stimulated bone marrow contained a higher number of nucleated cells, CFU-GM and CD34+ cells (P < 0.01). The hematopoetic reconstitution was accelerated. Until granulocyte counts exceeded 0.5 x 10(9)/L and plalete counts exceeded 20 x 10(9)/L, the days were 16.7 +/- 3.2 and 18.4 +/- 3.0 days as compared with those of the control group (22.5 +/- 5.1 and 26.3 +/- 5.9 days respectively, P < 0.01). The incidence of grade II-IV aGVHD was very low, only one case with grade II aGVHD on the skin in the study group. Four out of fifteen patients (26.7%) in the control group had grade II-IV aGVHD (P < 0.05). The number of T lymphocyte subsets in the harvested BM stimulated by G-CSF changed. In comparison with the control group, CD4+ decreased and CD8+ increased significantly (P < 0.01). The changes of progenitor cells and T lymphocyte subsets in BM from pre- to post-G-CSF stimulation indicated that the percentage of CD4+ cells reduced (P < 0.05), that of CD8+ cells, and that of CD34+ increased (P < 0.01). The incidence of chronic GVHD and relapse of leukemia were not different significantly between both groups.

CONCLUSIONS

Allogenic bone marrow transplant (Allo-BMT) donors given G-CSF can accelerate engraftment and minimize the incidence of severe aGVHD. There is a trend in favour of improved transplant-related complications.

摘要

目的

探讨在异基因骨髓移植（Allo - BMT）中使用来格司亭刺激供体骨髓加速造血重建及降低移植物抗宿主病（GVHD）的疗效，并评估其初步生物学机制。

方法

对30例白血病患者（研究组）的供体在采集骨髓前7天给予来格司亭3 - 4微克·千克⁻¹·天⁻¹。将受体随后的植入结果与15例未使用粒细胞集落刺激因子（G - CSF）的供体（对照组）进行比较。对5例供体自身进行研究，以评估来格司亭对骨髓中造血祖细胞和淋巴细胞亚群的影响。

结果

刺激后的骨髓含有更多的有核细胞、粒 - 巨噬细胞集落形成单位（CFU - GM）和CD34⁺细胞（P < 0.01）。造血重建加速。粒细胞计数超过0.5×10⁹/L且血小板计数超过20×10⁹/L时，研究组所需天数分别为16.7±3.2天和18.4±3.0天，而对照组分别为22.5±5.1天和26.3±5.9天（P < 0.01）。Ⅱ - Ⅳ级急性移植物抗宿主病（aGVHD）的发生率非常低，研究组仅1例出现皮肤Ⅱ级aGVHD。对照组15例患者中有4例（26.7%）发生Ⅱ - Ⅳ级aGVHD（P < 0.05）。G - CSF刺激后采集的骨髓中T淋巴细胞亚群数量发生变化。与对照组相比，CD4⁺减少，CD8⁺显著增加（P < 0.01）。从G - CSF刺激前到刺激后骨髓中祖细胞和T淋巴细胞亚群的变化表明，CD4⁺细胞百分比降低（P < 0.05），CD8⁺细胞和CD34⁺细胞百分比增加（P < 0.01）。两组慢性GVHD的发生率和白血病复发率无显著差异。