Schnabel B, Schmidmaier R, Franke D, Emmerich B, Straka C
Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany.
Cytotherapy. 2006;8(5):473-9. doi: 10.1080/14653240600941531.
High-dose chemotherapy with autologous stem cell transplantation is the standard treatment of eligible patients with multiple myeloma. However, this treatment is associated with a substantial risk of infectious complications during leukopenia. The aim of our pilot study was to determine the residual leukocyte subsets during severe cytopenia after high-dose melphalan and to correlate this with the occurrence of neutropenic fever.
Residual leukocyte subsets in the peripheral blood on days 4-7 following autologous stem cell transplantation were analyzed by three-color flow cytometry in 20 patients with multiple myeloma. In addition, we determined the number of T cells that were transfused with the autografts.
Absolute numbers of lymphocytes (mean 25/microL) and monocytes (mean 4/microL) were strongly reduced but rather constant during the period of severe neutropenia. Neutrophil engraftment and duration of neutropenia were very similar in patients with and without neutropenic fever. Low absolute lymphocyte counts and absolute CD4+ T-cell counts on days 4-7 after stem cell transplantation correlated with neutropenic fever. Furthermore, T-cell numbers in the autologous stem cell grafts that the patients received were significantly lower in patients with neutropenic fever.
These observations suggest that the number of T cells, and in particular CD4+ T cells, in the blood during severe cytopenia is playing a role in defense of infection. T-cell numbers in the graft could provide a predictive factor for the risk of infection in the post-transplant period. However, this needs to be confirmed in a larger study.
大剂量化疗联合自体干细胞移植是符合条件的多发性骨髓瘤患者的标准治疗方法。然而，这种治疗与白细胞减少期间感染并发症的重大风险相关。我们的初步研究目的是确定大剂量美法仑治疗后严重血细胞减少期间残留的白细胞亚群，并将其与中性粒细胞减少性发热的发生相关联。
对20例多发性骨髓瘤患者在自体干细胞移植后第4至7天的外周血中残留的白细胞亚群进行三色流式细胞术分析。此外，我们确定了自体移植物中输注的T细胞数量。
淋巴细胞（平均25/微升）和单核细胞（平均4/微升）的绝对数量在严重中性粒细胞减少期间大幅减少但相当稳定。有或无中性粒细胞减少性发热的患者中性粒细胞植入和中性粒细胞减少持续时间非常相似。干细胞移植后第4至7天的低绝对淋巴细胞计数和绝对CD4 + T细胞计数与中性粒细胞减少性发热相关。此外，发生中性粒细胞减少性发热的患者接受的自体干细胞移植物中的T细胞数量明显更低。
这些观察结果表明，严重血细胞减少期间血液中T细胞，特别是CD4 + T细胞的数量在感染防御中起作用。移植物中的T细胞数量可为移植后感染风险提供预测因素。然而，这需要在更大规模的研究中得到证实。
