超越 CD34+ 细胞剂量：外周血造血干细胞动员方法（粒细胞集落刺激因子[G-CSF]、G-CSF 加plerixafor 或环磷酰胺 G-CSF/粒细胞-巨噬细胞[GM]-CSF）对集落形成单位-GM 数量、植入和第 100 天造血移植物功能的影响。

Beyond CD34+ cell dose: impact of method of peripheral blood hematopoietic stem cell mobilization (granulocyte-colony-stimulating factor [G-CSF], G-CSF plus plerixafor, or cyclophosphamide G-CSF/granulocyte-macrophage [GM]-CSF) on number of colony-forming unit-GM, engraftment, and Day +100 hematopoietic graft function.

机构信息

Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

出版信息

Transfusion. 2011 Sep;51(9):1995-2000. doi: 10.1111/j.1537-2995.2011.03085.x. Epub 2011 Mar 10.

DOI:10.1111/j.1537-2995.2011.03085.x

PMID:21392017

Abstract

BACKGROUND

The dose of CD34+ cells/kg in the mobilized peripheral blood product is the main determinant of neutrophil and platelet (PLT) engraftment after autologous hematopoietic stem cell transplantation (AHSCT). Whether the method of mobilization, namely, granulocyte-colony-stimulating factor (G-CSF) alone (G), G-CSF plus plerixafor (G+P), or cyclophosphamide + G/granulocyte-macrophage (GM)-CSF (Cy+G/GM), independently affects number of colony-forming unit (CFU)-GM, engraftment, and hematopoietic graft function is unknown.

STUDY DESIGN AND METHODS

We used a database of AHSCT patients with multiple myeloma or lymphoma to identify three groups with different mobilization strategies receiving transplantation with similar CD34+ cell doses. Groups were compared in terms of CFU-GM, ratio of CFU-GM/CD34+, engraftment of neutrophils and PLTs, and hematopoietic graft function on Day +100.

RESULTS

Ninety-six patients were included in the analysis, 26 G, 32 G+P, and 38 Cy+G/GM, with median cell doses of 4.21 × 10(6) , 4.11 × 10(6) , and 4.67 × 10(6) CD34+/kg, respectively (p = 0.433). There was no significant difference in number of CFU-GM between the three groups; however, the ratio of CFU-GM/CD34+ was significantly lower for G+P (p = 0.008). Median time for neutrophil engraftment was 13 days in G+P and 12 days in G and Cy+G/GM (p = 0.028), while PLT engraftment happened at a median of 14.5 days in G+P versus 12 days in G and 11 days in Cy+G/GM (p = 0.012). There was no difference in hematopoietic graft function at Day +100.

CONCLUSION

Plerixafor-based mobilization is associated with slightly reduced number of CFU-GM and minimal delay in engraftment that is independent of CD34+ cell dose. Hematopoietic graft function on Day 100 is not affected by mobilization strategy.

摘要

背景

在外周血造血干细胞动员产物中 CD34+细胞/kg 的剂量是自体造血干细胞移植（AHSCT）后中性粒细胞和血小板（PLT）植入的主要决定因素。动员方法（即粒细胞集落刺激因子（G-CSF）单药（G）、G-CSF 加plerixafor（G+P）或环磷酰胺+G/粒细胞巨噬细胞（GM）-CSF（Cy+G/GM））是否独立影响集落形成单位（CFU）-GM、植入和造血移植物功能尚不清楚。

研究设计与方法

我们使用多发性骨髓瘤或淋巴瘤 AHSCT 患者的数据库来确定具有不同动员策略的三组患者，他们接受了相似 CD34+细胞剂量的移植。比较了 CFU-GM、CFU-GM/CD34+ 比值、中性粒细胞和 PLT 植入以及第 100 天的造血移植物功能。

结果

96 例患者纳入分析，26 例 G 组、32 例 G+P 组和 38 例 Cy+G/GM 组，细胞剂量中位数分别为 4.21×10(6)、4.11×10(6)和 4.67×10(6) CD34+/kg（p=0.433）。三组 CFU-GM 数量无显著差异；然而，G+P 组 CFU-GM/CD34+比值显著较低（p=0.008）。中性粒细胞植入的中位时间在 G+P 和 G 组为 13 天，在 Cy+G/GM 组为 12 天（p=0.028），而 PLT 植入的中位时间在 G+P 组为 14.5 天，在 G 组为 12 天，在 Cy+G/GM 组为 11 天（p=0.012）。第 100 天的造血移植物功能无差异。