Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway.
Cytotherapy. 2011 Sep;13(8):1013-24. doi: 10.3109/14653249.2011.574117. Epub 2011 Apr 20.
High-dose chemotherapy followed by autologous stem cell transplantation has been used extensively during the last two decades in the treatment of hematologic malignancies. The vast majority of recent transplantations have been performed using mobilized peripheral blood stem cells, because they have become the preferred source of hematopoietic cells rather than bone marrow stem cells. The mobilization is achieved by growth factors, eventually combined with chemotherapy, and the cells are then harvested and cryopreserved until reinfusion. Despite extensive use for many years, few attempts have been made to standardize the various steps in mobilization, harvesting and cryopreservation. Furthermore, the autografts only represent relative stem cell enrichment and contain a wide range of more mature hematopoietic and immunocompetent cells; the potential clinical importance of these normal cells is largely unknown and represents an additional non-standardized factor in this treatment. We have reviewed the various methodologic approaches for stem cell mobilization, collection and cryopreservation of autografts with a special focus on the cryopreservation procedures, immunocompetent cells in the graft, and cytokine content of the graft supernatant. We conclude that the factors/aspects mentioned above should be standardized in future clinical studies of autotransplantation for human hematologic malignancies. Alternatively, detailed methodologic descriptions should be required when the results are published. Standardization of autograft preparation and cryopreservation will be achieved if/when transplantation units assess and adopt new standards based not only on the technology but, more importantly, on the quality of evidence and data related to that technology/methodology.
在过去的二十年中，大剂量化疗后自体干细胞移植已广泛应用于血液系统恶性肿瘤的治疗。最近绝大多数移植都是使用动员外周血造血干细胞进行的，因为它们已成为造血细胞而不是骨髓干细胞的首选来源。通过生长因子实现动员，最终与化疗联合使用，然后收获和冷冻保存细胞，直到再输注。尽管多年来广泛应用，但很少有尝试来标准化动员、收获和冷冻保存的各个步骤。此外，自体移植物仅代表相对的干细胞富集，含有广泛的更成熟的造血和免疫活性细胞；这些正常细胞的潜在临床重要性在很大程度上是未知的，并且是这种治疗中的另一个非标准化因素。我们回顾了自体干细胞动员、采集和冷冻保存的各种方法学方法，特别关注冷冻保存程序、移植物中的免疫活性细胞和移植物上清液中的细胞因子含量。我们得出结论，在未来的人类血液系统恶性肿瘤自体移植临床研究中，应该标准化上述因素/方面。或者，在发表结果时，应该需要详细的方法学描述。如果/当移植单位不仅基于技术，而且更重要的是基于与该技术/方法相关的证据和数据质量来评估和采用新标准，那么自体移植物制备和冷冻保存的标准化将得以实现。
