Carral A, de la Rubia J, Martín G, Martínez J, Sanz G, Jarque I, Sempere A, Soler M A, Marty M L, Sanz M A
Hematology Service. University Hospital La Fe, Valencia, Spain.
Bone Marrow Transplant. 2002 May;29(10):825-32. doi: 10.1038/sj.bmt.1703566.
Factors influencing hematopoietic recovery (HR) after autologous blood stem cell transplantation (ABSCT) were analyzed in 73 patients with various non-myeloid malignancies (NMM), and in 58 patients with acute myeloblastic leukemia (AML). Peripheral blood stem cells were collected following mobilization with chemotherapy, granulocyte colony-stimulating factor (G-CSF), or chemotherapy plus G-CSF. The conditioning regimen used consisted of either chemotherapy alone (112 cases) or chemotherapy plus total body irradiation (19 cases). The median number of colony-forming units granulocyte-macrophage (CFU-GM) was similar in both groups of patients, with the median number of CD34(+) cells infused being higher in the AML group (5.4 vs 4 x 10(6)/kg; P = 0.03). Median time neutrophils >0.5 x 10(9)/l was 13 days in both groups, and median time to a platelet count >20 x 10(9)/l was longer in AML patients (14 vs 12 days; P = 0.01). In multivariate analysis, the only factors affecting neutrophil recovery in the NMM group were the CD34+ cell number (continuous model) and the CFU-GM dose (categorized model) infused, whereas for platelet recovery, previous chemotherapy also remained significant. In the AML group, the only factors significantly affecting the speed of neutrophil recovery were dose of CD34+ cells administered and the patient's age. As for platelet recovery, only the progenitor dose administered remained significant. In the NMM group, the most discriminating cut-off values for a rapid neutrophil and platelet recovery were 1.5 x 10(6) and 2.5 x 10(6) CD34+ cells/kg, respectively, and for AML patients these figures were 1.5 x 10(6) and 4 x 10(6) CD34+ cells/kg, respectively. Our results confirm the slower HR after ABSCT in AML, and highlight the importance of progenitor cell dose in accelerating HR after ABSCT.
对73例患有各种非髓系恶性肿瘤（NMM）的患者以及58例急性髓细胞白血病（AML）患者进行了分析，以研究自体血干细胞移植（ABSCT）后影响造血恢复（HR）的因素。采用化疗、粒细胞集落刺激因子（G-CSF）或化疗加G-CSF动员后采集外周血干细胞。所采用的预处理方案包括单纯化疗（112例）或化疗加全身照射（19例）。两组患者的粒细胞-巨噬细胞集落形成单位（CFU-GM）中位数相似，AML组输注的CD34(+)细胞中位数较高（5.4对4×10(6)/kg；P = 0.03）。两组中性粒细胞>0.5×10(9)/l的中位时间均为13天，AML患者血小板计数>20×10(9)/l的中位时间更长（14天对12天；P = 0.01）。多因素分析显示，NMM组影响中性粒细胞恢复的唯一因素是输注的CD34+细胞数量（连续模型）和CFU-GM剂量（分类模型），而对于血小板恢复，既往化疗也仍然具有显著影响。在AML组，显著影响中性粒细胞恢复速度的唯一因素是给予的CD34+细胞剂量和患者年龄。至于血小板恢复，只有给予的祖细胞剂量仍然具有显著影响。在NMM组，快速中性粒细胞和血小板恢复的最具鉴别性的临界值分别为1.5×10(6)和2.5×10(6) CD34+细胞/kg，而对于AML患者，这些数字分别为1.5×10(6)和4×10(6) CD34+细胞/kg。我们的结果证实了AML患者ABSCT后HR较慢，并强调了祖细胞剂量在加速ABSCT后HR中的重要性。
