Körbling M
M. D. Anderson Cancer Center, University of Texas, Houston.
Beitr Infusionsther. 1991;28:233-41.
It is widely believed that hemopoietic stem cells have to be mobilized from extravascular sites into the circulation to guarantee a sufficient and safe blood stem cell autograft. The question of using mobilized or non-mobilized stem cells for transplantation purposes addresses the quality of hemopoietic engraftment rather than its feasibility. Two aspects are of clinical relevance: 1. The increment of peripheral cell concentration per time, and 2. shortening the duration of total aplasia following myeloablation and stem cell transplantation. When comparing the various stem cell mobilization techniques the CFU-GM yield per apheresis was highest during rh GM-CSF application (250 micrograms/m2/day continuous i.v. infusion), whereas the MNC yield was not greatly affected. More severe side effects were seen during rh GM-CSF infusion: One patient experienced an axillary phlebothrombosis. In a series of 15 advanced stage Hodgkin's lymphoma patients the reconstitutive ability of the various stem cell autografts, whether chemotherapy-, cytokine-, or non-mobilized, did not vary. Particularly in acute leukemias, mobilization of hemopoietic precursor cells does not necessarily exclude a concomitant mobilization of clonogenic tumor cells, and, therefore, the probability of disease-free survival after ABSCT might be lower when using mobilized stem cells for transplant.
人们普遍认为，造血干细胞必须从血管外部位动员到循环系统中，以确保获得充足且安全的血液干细胞自体移植物。使用动员的或未动员的干细胞进行移植的问题，涉及造血植入的质量而非其可行性。有两个方面具有临床相关性：1. 外周血细胞浓度随时间的增加，以及2. 缩短清髓和干细胞移植后全血细胞缺乏的持续时间。在比较各种干细胞动员技术时，rh GM-CSF应用期间（250微克/平方米/天持续静脉输注）每次单采的CFU-GM产量最高，而单个核细胞产量受影响不大。rh GM-CSF输注期间出现了更严重的副作用：1例患者发生腋窝静脉血栓形成。在一组15例晚期霍奇金淋巴瘤患者中，各种干细胞自体移植物（无论是化疗、细胞因子或未动员的）的重建能力并无差异。特别是在急性白血病中，造血前体细胞的动员不一定排除克隆性肿瘤细胞的同时动员，因此，使用动员的干细胞进行移植时，自体骨髓干细胞移植后无病生存的概率可能较低。
