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儿童异基因供者外周血祖细胞采集的不良事件:与采集及安全性概况相关的变量

Peripheral blood progenitor cell collection adverse events for childhood allogeneic donors: variables related to the collection and safety profile.

作者信息

Sevilla Julián, González-Vicent Marta, Lassaletta Alvaro, Ramírez Manuel, Pérez-Martínez Antonio, Madero Luis, Díaz Miguel Angel

机构信息

Servicio de Transfusión, Hospital Infantil Universitario Niño Jesús, Avd Menéndez Pelayo 65, Madrid, Spain.

出版信息

Br J Haematol. 2009 Mar;144(6):909-16. doi: 10.1111/j.1365-2141.2008.07529.x. Epub 2008 Dec 12.

Abstract

The use of children as haematopoietic stem cell donors represents an ethical dilemma. For some investigators, this is even more questionable if the children underwent peripheral blood progenitor cell (PBPC) collection. Due to these controversies, information related to adverse events (AE) in paediatric donors and variables related to the collection is scanty. We analysed 152 PBPC collections, and compared the complications and results between young children, older children and adults. The pattern of AE was shown to vary according to the age of the donor. Older paediatric donors and adults had a higher incidence of complaints related to PBPC priming (54.3% vs. 79.7%, respectively) than the youngest children (12%). On the other hand, these donors had a lower incidence of AE during PBPC collection (19.6% older children, 37.3% adults) mainly related to hypocalcaemia, than the youngest donors, who suffered mainly cardiovascular complications due to hypovolaemia (51.7%). The only variables related to collected cell dose were total blood volume processed per donor body weight, and CD34(+) cell count before apheresis. The donor/recipient body weight ratio predicted the outcome of collection in a single large volume leukapheresis. Donors with body weight ratio >or=0.75 had 4.69 times higher likelihood to reach the minimum target cell dose.

摘要

将儿童用作造血干细胞供体存在伦理困境。对于一些研究人员来说,如果儿童接受外周血祖细胞(PBPC)采集,这一问题就更值得质疑。由于这些争议,有关儿科供体不良事件(AE)以及与采集相关变量的信息很少。我们分析了152次PBPC采集,并比较了幼儿、大龄儿童和成人之间的并发症及结果。结果显示,AE模式因供体年龄而异。大龄儿科供体和成人与PBPC动员相关的不适发生率(分别为54.3%和79.7%)高于最小的儿童(12%)。另一方面,这些供体在PBPC采集期间的AE发生率(大龄儿童为19.6%,成人为37.3%)主要与低钙血症有关,低于最小的供体,后者主要因血容量不足而出现心血管并发症(51.7%)。与采集的细胞剂量相关的唯一变量是每个供体体重所处理的全血量以及单采前的CD34(+)细胞计数。供体/受体体重比可预测单次大容量白细胞单采的采集结果。体重比≥0.75的供体达到最低目标细胞剂量的可能性高4.69倍。

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