Hill Q A, Buxton D, Pearce R, Gesinde M O, Smith G M, Cook G
Department of Haematology, Leeds General Infirmary, Leeds, UK.
Bone Marrow Transplant. 2007 Nov;40(10):925-30. doi: 10.1038/sj.bmt.1705847. Epub 2007 Sep 10.
Increasing demand on the apheresis service makes efficient harvesting of peripheral blood stem cells (PBSCs) essential. A total of 168 adult patients with haematological malignancy were primed using low-moderate dose cyclophosphamide (1.5-3 g/m(2)) with G-CSF 5-10 microg/kg per day. Harvesting was booked and peripheral blood (PB) counts first checked between 6 and 10 days post-priming. One hundred and thirty (77%) patients harvested successfully (total harvest yield > or =2 x 10(6) CD34(+)/kg) and the median PBSC collection per procedure was 2.18 x 10(6)/kg (range 0.1-14.5). Only more lines of prior chemotherapy predicted failure to harvest in multivariate analysis (P=0.003). The PB CD34(+) cell count correlated significantly with harvest yield (r=0.8448, P<0.0001). A PB CD34(+) count > or =10/microl predicted a collection of > or =2 x 10(6)/kg (positive-predictive value of 61%, negative-predictive-value 100%). Patients first attending day 9 required significantly fewer visits to achieve a successful harvest than those first attending days 6-8 without increasing the risk of failure. No significant difference in failure rates, number of days attending and total harvest yield was found between days 9 and 10 attendees. Collection from day 9 may however enable higher target yields to be achieved. PB CD34(+) count monitoring should commence and harvesting booked from day 9 to optimize both the harvest and the efficiency of the PBSC harvesting service.
对单采服务需求的不断增加使得高效采集外周血干细胞（PBSC）至关重要。共有168例血液系统恶性肿瘤成年患者使用低 - 中剂量环磷酰胺（1.5 - 3 g/m²）联合每天5 - 10 μg/kg的粒细胞集落刺激因子（G - CSF）进行预处理。采集时间预定在预处理后6至10天之间，首先检查外周血（PB）计数。130例（77%）患者成功采集（总采集产量≥2×10⁶ CD34⁺/kg），每次采集的PBSC中位数为2.18×10⁶/kg（范围0.1 - 14.5）。在多因素分析中，仅先前化疗的疗程数更多预示着采集失败（P = 0.003）。PB CD34⁺细胞计数与采集产量显著相关（r = 0.8448，P < 0.0001）。PB CD34⁺计数≥10/μl预示采集量≥2×10⁶/kg（阳性预测值为61%，阴性预测值为100%）。首次在第9天就诊的患者与首次在第6 - 8天就诊的患者相比，实现成功采集所需的就诊次数显著减少，且不增加失败风险。在第9天和第10天就诊的患者之间，失败率、就诊天数和总采集产量无显著差异。然而，从第9天开始采集可能使达到更高的目标产量成为可能。应从第9天开始监测PB CD34⁺计数并预定采集，以优化PBSC采集和单采服务的效率。
