Gidron A, Verma A, Doyle M, Boggio L, Evens A, Gordon L, Singhal S, Tallman M, Williams S, Winter J, Mehta J
Hematopoietic Stem Cell Transplant Program, Division of Hematology/Oncology, The Feinberg School of Medicine, The Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
Bone Marrow Transplant. 2005 Feb;35(3):243-6. doi: 10.1038/sj.bmt.1704781.
A total of 415 leukaphereses in 201 patients stimulated with growth factor (GF; n = 119) or chemotherapy-GF (n = 296) were studied to determine CD34+ cell collection efficiency (CE). The pre-apheresis leukocyte count was 1-93 x 10(9)/l (median 20), and peripheral blood CD34 count (PBCD34) was 1-1104/microl (median 19). The total number of CD34+ cells collected was 4-6531 x 10(6) (median 151); corresponding to 0.1-111.4 x 10(6) (median 2.3) per kg. There was strong correlation between PBCD34 and the number of CD34+ cells collected (r = 0.9; P < 0.0001). CE was 7-145% (median 46). On multiple regression analysis, a higher leukocyte count (P < 0.0001) was the most important predictor of lower CE. CE with leukocytes < 20 was 7-145% (median 53%) compared to 10-132% (median 40%) with leukocyte > or = 20 (P < 0.0001). In all, 61% of the apheresis procedures performed after chemotherapy-GF occurred when leukocytes were < 20 compared to 21% of those performed after GF alone (P < 0.0001). We conclude that mobilizing patients with the combination of chemotherapy and GF rather than GF alone leads to leukapheresis being performed when the leukocyte count is low -- in a range that results in optimum CD34+ cell CE. Autologous stem cells should be mobilized with chemotherapy-GF rather than GF alone whenever possible.
对201例接受生长因子（GF；n = 119）或化疗联合生长因子（n = 296）刺激的患者进行的总共415次白细胞单采术进行了研究，以确定CD34+细胞采集效率（CE）。单采术前白细胞计数为1 - 93×10⁹/L（中位数为20），外周血CD34计数（PBCD34）为1 - 1104/μl（中位数为19）。采集的CD34+细胞总数为4 - 6531×10⁶（中位数为151）；相当于每千克0.1 - 111.4×10⁶（中位数为2.3）。PBCD34与采集的CD34+细胞数量之间存在强相关性（r = 0.9；P < 0.0001）。CE为7% - 145%（中位数为46%）。多因素回归分析显示，较高的白细胞计数（P < 0.0001）是CE降低的最重要预测因素。白细胞计数<20时的CE为7% - 145%（中位数为53%），而白细胞计数≥20时为10% - 132%（中位数为40%）（P < 0.0001）。总体而言，化疗联合生长因子后进行的单采术中，61%是在白细胞计数<20时进行的，而单独使用生长因子后进行的单采术中这一比例为21%（P < 0.0001）。我们得出结论，化疗联合生长因子动员患者而非单独使用生长因子，会导致在白细胞计数较低时进行白细胞单采术——这一范围内可实现最佳的CD34+细胞CE。只要有可能，自体干细胞应采用化疗联合生长因子而非单独使用生长因子进行动员。
