Zhou Li-Kun, Chen Hui-Ren, Wang Heng-Xiang, Yan Hong-Min, Duan Lian-Ning, Zhu Ling, Xue Mei, Liu Jing, Ji Shu-Quan
China Medical University Postgraduate School, Shenyang 110001, Liaoning Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2008 Dec;16(6):1344-9.
This study was purposed to investigate the correlation between the dose infused megakaryocytic precursors (CD34+, CD34+CD61+) and recovery time of platelet count following an allogeneic PBSCT and/or BMT through quantitative detection of CD34+ and its subpopulation in peripheral blood and BM mobilized by G-CSF. 24 patients with various hematologic malignancies received PBSCT/BMT from their HLA matched or unrelated donors and haploidentical siblings in April-December 2007. 20 evaluated patients were divided into 2 groups according to different transplant schemes. HLA matched group received PBSCT regime and haploidentical group received PBSCT combined with BMT. CD34+CD61+ subpopulations in sample from patients receiving PBSCT/BMT were measured by flow cytometry immediately or storage over night. The results showed that the median number of infused CD34+, CD34+CD61+ and CD34-CD61+ cells in haploidentical group were 6.24x10(6)/kg (1.53-20.48), 66.19x10(4)/kg (8.16-493.83), and 34.38x10(6)/kg (14.71-109.16) respectively, in HLA matched group those were 4.88x10(6)/kg (1.00-8.24), 14.16x10(4)/kg (11.63-96.87), and 13.50x10(6)/kg (1.74-35.61), respectively. Median days of ANCs>0.5x10(9)/L and platelets>20x10(9)/L were 18.5 (11.0-29.0) days and 16.5 (9.0-35.0) days in haploidentical group respectively; in HLA matched group those were 14.5 (9.0-24.0) and 10.5 (6.0-37.0) respectively. A significance difference of median days for ANC engraftment presented between two groups (p=0.048). There was no significant difference of time for platelet engraftment between 2 groups. For patients with CD34+ cell dose>2x10(6)/kg there was significant difference of time of platelet engraftment between HLA matched and haploidentical groups (p=0.006). The number of CD34+CD61+ cells infused in 12 haploidentical patients or in 8 HLA matched patients were much better correlated with the time of platelet recovery up to 20x10(9)/L than that of number of CD34+ cells infused in total 20 patients (r=-0.768 and p=0.004 for haploidentical CD34+CD61+ cells, r=-0.747 and p=0.033 for HLA matched CD34+ CD61+ cells, r=-0.449 and p=0.047 for CD34+ cells). There was an inverse correlation between the number of infused CD34+ CD61+ cells and time of platelet engraftment. Therefore, as the number of CD34+ CD61+ cells increased, duration of platelet engraftment (time to reach platelet count of 20x10(9)/L) shortened significantly. It is concluded that the determining the number of megakaryocytic precursor by flow cytometry may predict the platelet reconstitutive capacity of the allogeneic hematopoietic stem cell transplantation, which is in haploidentical PBSCT and in BMT.
本研究旨在通过定量检测经粒细胞集落刺激因子（G-CSF）动员的外周血和骨髓中CD34+及其亚群，探讨异基因外周血干细胞移植（PBSCT）和/或骨髓移植（BMT）后输注的巨核细胞前体细胞（CD34+、CD34+CD61+）剂量与血小板计数恢复时间之间的相关性。2007年4月至12月，24例各种血液系统恶性肿瘤患者接受了来自HLA配型相合或不相合供者及单倍型相合同胞的PBSCT/BMT。20例可评估患者根据不同移植方案分为2组。HLA配型相合组接受PBSCT方案，单倍型相合组接受PBSCT联合BMT。对接受PBSCT/BMT患者样本中的CD34+CD61+亚群立即或过夜保存后通过流式细胞术进行检测。结果显示，单倍型相合组输注的CD34+、CD34+CD61+和CD34-CD61+细胞中位数分别为6.24×10⁶/kg（1.53 - 20.48）、66.19×10⁴/kg（8.16 - 493.83）和34.38×10⁶/kg（14.71 - 109.16）；HLA配型相合组分别为4.88×10⁶/kg（1.00 - 8.24）、14.16×10⁴/kg（11.63 - 96.87）和13.50×10⁶/kg（1.74 - 35.61）。单倍型相合组中性粒细胞绝对计数（ANCs）>0.5×10⁹/L和血小板>20×10⁹/L的中位数天数分别为18.5（11.0 - 29.0）天和16.5（9.0 - 35.0）天；HLA配型相合组分别为14.5（9.0 - 24.0）天和10.5（6.0 - 37.0）天。两组之间中性粒细胞植入中位数天数存在显著差异（p = 0.048）。两组之间血小板植入时间无显著差异。对于CD34+细胞剂量>2×10⁶/kg的患者，HLA配型相合组和单倍型相合组之间血小板植入时间存在显著差异（p = 0.006）。12名单倍型相合患者或8名HLA配型相合患者输注的CD34+CD61+细胞数量与血小板恢复至20×10⁹/L的时间的相关性，比20例患者输注的CD34+细胞数量与血小板恢复时间的相关性更好（单倍型相合CD34+CD61+细胞：r = -0.768，p = 0.004；HLA配型相合CD34+CD61+细胞：r = -0.747，p = 0.033；CD34+细胞：r = -0.449，p = 0.047）。输注的CD34+CD61+细胞数量与血小板植入时间呈负相关。因此，随着CD34+CD61+细胞数量增加，血小板植入持续时间（达到血小板计数20×10⁹/L的时间）显著缩短。结论是，通过流式细胞术测定巨核细胞前体细胞数量可预测异基因造血干细胞移植（包括单倍型相合PBSCT和BMT）的血小板重建能力。
