Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Transfusion. 2013 Jul;53(7):1501-9. doi: 10.1111/j.1537-2995.2012.03911.x. Epub 2012 Oct 3.
Peripheral blood stem cells (PBSCs) are the preferred source in autologous transplantation. We assessed prospectively the efficacy of mobilization in pediatric patients and risk factors associated with its failure.
Patients, aged 0 to 17 years, needing a first collection of PBSCs for autologous stem cell transplantation were eligible. The study period was from July 2008 to September 2010. A blood peak of fewer than 20 × 10(6) CD34+ cells/L was used as the cutoff to define a poor mobilizer.
A total of 145 patients, 57% male (82) and 43% female (63), with a median age of 7 years, affected by solid tumor, 79% (114), and acute leukemia or lymphoma, 21% (31), were enrolled. Granulocyte-colony-stimulating factor used was filgrastim in 69%, lenograstim in 26%, and pegfilgrastim in 5% of patients. A total of 83% (121) of patients mobilized successfully, the median CD34+ count being 120 × 10(6) /L (range, 23 × 10(6) -1840 × 10(6) /L). A single leukapheresis procedure was sufficient to achieve the target CD34+ cell dose in 82% (99/121) of patients. Among 24 poor mobilizer patients, 15 underwent a second mobilizing course and nine required a marrow harvest. Factors associated with poor mobilization were metastatic disease and relapse. Among 99 patients who underwent autologous stem cell transplantation, the median times to neutrophil and platelet engraftment and of hospitalization were longer by 2, 12, and 6 days in poor versus good mobilizer group.
In pediatric patients undergoing a first mobilization, the incidence of poor mobilization was 17%. Failure of mobilization resulted in an increase in health costs and a longer hospitalization for those who underwent autologous stem cell transplantation.
外周血干细胞（PBSC）是自体移植的首选来源。我们前瞻性评估了儿科患者动员的效果及其失败的相关因素。
需要首次采集 PBSC 进行自体干细胞移植的 0 至 17 岁患者符合条件。研究期间为 2008 年 7 月至 2010 年 9 月。以血液中 CD34+细胞计数少于 20×10^6/L 作为定义动员不良的截定点。
共纳入 145 例患者，男 57%（82 例），女 43%（63 例），中位年龄为 7 岁，实体瘤占 79%（114 例），急性白血病或淋巴瘤占 21%（31 例）。粒细胞集落刺激因子使用非格司亭的占 69%，聚乙二醇化非格司亭的占 26%，培非格司亭的占 5%。83%（121 例）的患者成功动员，中位 CD34+计数为 120×10^6/L（范围，23×10^6-1840×10^6/L）。82%（99/121）的患者通过单次单采术即可达到目标 CD34+细胞剂量。在 24 例动员不良的患者中，15 例接受了第二次动员疗程，9 例需要进行骨髓采集。转移疾病和复发是动员不良的相关因素。在 99 例行自体干细胞移植的患者中，动员不良组中性粒细胞和血小板植入及住院时间分别延长 2、12 和 6 天。
在首次动员的儿科患者中，动员不良的发生率为 17%。动员失败导致那些接受自体干细胞移植的患者的医疗费用增加和住院时间延长。
