Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy.
Curr Opin Hematol. 2012 Nov;19(6):448-53. doi: 10.1097/MOH.0b013e32835903ab.
In the last few years, mobilized peripheral blood has overcome bone marrow as a graft source, but, despite the evidence of a more rapid engraftment, the incidence of chronic graft-versus-host disease is significantly higher with, consequently, more transplant-related mortality on the long follow-up. Overall, the posttransplant outcome of mobilized peripheral blood recipients is similar to that of patients who are bone marrow grafted. More recently, the use of bone marrow after granulocyte colony-stimulating factor (G-CSF) donor priming has been introduced in the transplant practice. Herein, we review biological acquisitions and clinical results on the use of G-CSF-primed bone marrow as a source of hematopoietic stem cells (HSC) for allogeneic stem cell transplantation.
G-CSF the increases the HSC compartment and exerts an intense immunoregulatory effect on marrow T-cells resulting in the shift from Th1 to Th2 phenotype with higher production of anti-inflammatory cytokines. The potential advantages of these biological effects have been translated in the clinical practice by using G-CSF primed unmanipulated bone marrow in the setting of transplant from human leukocyte antigen (HLA)-haploidentical donor with highly encouraging results.
For patients lacking an HLA-identical sibling, the transplant of G-CSF primed unmanipulated bone marrow from a haploidentical donor combined with an intense in-vivo immunosuppression is a valid alternative achieving results that are well comparable with those reported for umbilical cord blood, HLA-matched unrelated peripheral blood/bone marrow or T-cell-depleted haploidentical transplant.
在过去的几年中，动员的外周血已经超越骨髓成为移植物的来源，但尽管有更快植入的证据，但慢性移植物抗宿主病的发生率明显更高，因此在长期随访中移植相关死亡率更高。总的来说，动员外周血受者的移植后结果与骨髓移植患者相似。最近，在移植实践中引入了粒细胞集落刺激因子（G-CSF）供体预处理后骨髓的使用。在此，我们回顾了使用 G-CSF 预处理骨髓作为异基因造血干细胞（HSC）来源用于干细胞移植的生物学研究进展和临床结果。
G-CSF 增加了 HSC 池，并对骨髓 T 细胞产生强烈的免疫调节作用，导致 Th1 向 Th2 表型转变，产生更高水平的抗炎细胞因子。这些生物学效应的潜在优势已通过在 HLA 单倍体不相合供体移植中使用 G-CSF 预处理未处理的骨髓转化为临床实践，结果非常令人鼓舞。
对于缺乏 HLA 同型兄弟姐妹的患者，移植 G-CSF 预处理的未处理的来自单倍体不合供体的骨髓，结合强烈的体内免疫抑制，是一种有效的替代方法，可以实现与脐带血、HLA 匹配的无关外周血/骨髓或 T 细胞耗竭的单倍体不合移植相当的结果。
