Gunn Nathan, Damon Lloyd, Varosy Paul, Navarro Willis, Martin Tom, Ries Curt, Linker Charles
Department of Medicine, Division of Hematology/Oncology, University of California-San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
Biol Blood Marrow Transplant. 2003 Oct;9(10):643-8. doi: 10.1016/s1083-8791(03)00232-5.
We studied platelet engraftment in 58 patients with acute myeloid leukemia in first remission treated with autologous stem cell transplantation (ASCT) to determine whether CD34+ cell doses >10 x 10(6)/kg were associated with faster platelet engraftment. We compared engraftment rates in patients receiving CD34+ doses between 5 and 10 x 10(6)/kg (standard-dose ASCT) with those receiving doses > or =10 x 10(6)/kg (high-dose [HD] ASCT). We also studied neutrophil engraftment rates and platelet and red blood cell transfusion requirements. In multivariate adjusted models, the rate of platelet recovery to > or =20,000/microL was 4-fold greater among subjects who received HD-ASCT (hazard ratio [HR], 4.1; confidence interval [CI], 1.8-9.2; P =.001), with median recovery times of 14 versus 28 days. The rate of platelet recovery to > or =50,000/microL was 2-fold greater (HR, 2.1; CI, 1.3-5.9; P =.01), with median recovery times of 19 versus 46 days. Faster platelet recovery resulted in the need for fewer platelet transfusions among the subjects who received HD-ASCT (mean transfusions, 3.7 versus 9.8; P =.005). Although not statistically significant, neutrophil recovery data in the adjusted model suggested a similar effect in the HD-ASCT group, with faster engraftment times at absolute neutrophil counts >500/microL (median, 9.2 versus 12 days; HR, 1.6; CI, 0.69-3.5; P =.29) and absolute neutrophil counts >1000/microL (median, 9.5 versus 12 days; HR, 1.3; CI, 0.56-2.8; P =.58). Subjects who received HD-ASCT required fewer red blood cell transfusions (4.0 versus 9.8 units; P =.01). Our findings suggest that CD34+ cell doses >10 x 10(6)/kg CD34+ result in faster engraftment and fewer red blood cell and platelet transfusions.
我们研究了58例首次缓解期急性髓系白血病患者接受自体干细胞移植（ASCT）后的血小板植入情况，以确定CD34+细胞剂量>10×10⁶/kg是否与更快的血小板植入相关。我们比较了接受5至10×10⁶/kg CD34+剂量（标准剂量ASCT）的患者与接受剂量≥10×10⁶/kg（高剂量[HD]ASCT）的患者的植入率。我们还研究了中性粒细胞植入率以及血小板和红细胞输注需求。在多变量调整模型中，接受HD-ASCT的受试者血小板恢复至≥20,000/μL的速率高出4倍（风险比[HR]，4.1；置信区间[CI]，1.8 - 9.2；P = 0.001），中位恢复时间分别为14天和28天。血小板恢复至≥50,000/μL的速率高出2倍（HR，2.1；CI，1.3 - 5.9；P = 0.01），中位恢复时间分别为19天和46天。更快的血小板恢复使得接受HD-ASCT的受试者所需的血小板输注次数减少（平均输注次数，3.7次对9.8次；P = 0.005）。虽然无统计学显著性，但调整模型中的中性粒细胞恢复数据表明HD-ASCT组有类似效果，在绝对中性粒细胞计数>500/μL时植入时间更快（中位时间，9.2天对12天；HR，1.6；CI，0.69 - 3.5；P = 0.29）以及绝对中性粒细胞计数>1000/μL时（中位时间，9.5天对12天；HR，1.3；CI，0.56 - 2.8；P = 0.58）。接受HD-ASCT的受试者所需的红细胞输注次数较少（4.0单位对9.8单位；P = 0.0
