Reddy Ramakrishna L
American Red Cross Midwest Region Blood Services and Department of Pathology and Microbiology, University of Nebraska Medical Center, 3838 Dewey Avenue, Omaha, NE 68105, USA.
Transfus Apher Sci. 2005 Feb;32(1):63-72. doi: 10.1016/j.transci.2004.10.007.
Bone marrow transplantation gradually expanded as a treatment modality for various malignant and non malignant disease conditions. Since the discoveries of the potential of Peripheral Blood Progenitor Cells (PBPC) in the hematopoietic reconstitution mid 1980s and early 1990s PBPC gradually replaced bone marrow as the preferred source of stem cells. The introduction of hematopoietic cytokines that can mobilize large number of progenitors into circulation accelerated PBPC usage. Technological advancements in the apheresis instrumentation greatly helped in the conversion from marrow to PBPC. PBPC collection is less painful, less expensive and transplant with PBPC results in faster hematological recovery than with marrow. Almost all of the autologous transplants are currently performed with PBPC and a similar trend is seen with the allogeneic transplants. The progenitor cell mobilization regimen for autologous patients can be cytokines alone or cytokines combined with chemotherapy. In the majority of the patients the required minimal cell dose of 2.5-5.0 x 10(6)/kg CD34+ cells can be collected in one or two apheresis collections. A few of autologous transplant patients who mobilize poorly require several collections. Allogeneic donors are generally mobilized with daily subcutaneous injections of G-CSF 10 microg/kg for 5 days. The PBPC are collected in one or two apheresis procedures. The side effects of G-CSF are generally mild to moderate; however rare serious reactions including rupture of the spleen have been reported. The collection of PBPC in pediatric patients poses additional challenges yet an adequate dose of cells can be collected with the available apheresis instrumentation. The apheresis collection procedures are safe with no serious adverse consequences. Future scientific advancements may expand the use of PBPC for other clinical application in addition to the current use for hematological reconstitution.
骨髓移植作为一种治疗各种恶性和非恶性疾病的方法逐渐得到推广。自20世纪80年代中期和90年代初发现外周血祖细胞（PBPC）在造血重建中的潜力以来，PBPC逐渐取代骨髓成为首选的干细胞来源。能够将大量祖细胞动员到循环中的造血细胞因子的引入加速了PBPC的应用。血液成分分离仪器的技术进步极大地推动了从骨髓向PBPC的转变。PBPC采集痛苦较小、成本较低，与骨髓移植相比，PBPC移植导致血液学恢复更快。目前几乎所有的自体移植都采用PBPC进行，同种异体移植也呈现出类似的趋势。自体患者的祖细胞动员方案可以是单独使用细胞因子或细胞因子与化疗联合使用。在大多数患者中，通过一到两次血液成分分离采集就可以收集到所需的最低细胞剂量2.5 - 5.0×10(6)/kg CD34+细胞。少数动员效果不佳的自体移植患者需要进行多次采集。同种异体供者一般通过每天皮下注射10μg/kg的粒细胞集落刺激因子（G-CSF），持续5天来进行动员。PBPC通过一到两次血液成分分离程序进行采集。G-CSF的副作用一般为轻至中度；然而，已有报道称罕见严重反应，包括脾破裂。儿科患者的PBPC采集带来了额外的挑战，但使用现有的血液成分分离仪器仍可采集到足够剂量的细胞。血液成分分离采集程序是安全的，没有严重不良后果。未来的科学进展可能会扩大PBPC在除目前用于造血重建之外的其他临床应用中的使用。
