Bai Lijun, Xia Wei, Wong Kelly, Reid Cassandra, Ward Christopher, Greenwood Matthew
Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Reserve Road, Sydney, St Leonards, NSW, 2065, Australia,
Ann Hematol. 2014 Oct;93(10):1655-64. doi: 10.1007/s00277-014-2112-2. Epub 2014 May 29.
Engraftment outcomes following autologous transplantation correlate poorly to infused stem cell number. We evaluated 446 consecutive patients who underwent autologous transplantation at our centre between 2001 and 2012. The impact of pre-transplant and collection factors together with CD34(+) dosing ranges on engraftment, hospital length of stay (LOS) and survival endpoints were assessed in order to identify factors which might be optimized to improve outcomes for patients undergoing autologous transplantation using haemopoietic progenitor cells-apheresis (HPC-A). Infused CD34(+) cell dose correlated to platelet but not neutrophil recovery. Time to platelet engraftment was significantly delayed in those receiving low versus medium or high CD34(+) doses. Non-remission status was associated with slower neutrophil and platelet recovery. Increasing neutrophil contamination of HPC-A was strongly associated with slower neutrophil recovery with infused neutrophil dose/kg recipient body weight ≥3 × 10(8)/kg having a significant impact on time to neutrophil engraftment (p = 0.001). Higher neutrophil doses/kg in HPC-A were associated with days of granulocyte colony stimulation factor (G-CSF) use, HPC-A volumes >500 ml and higher NCC in HPC-A. High infused neutrophil dose/kg and age >65 years were associated with longer hospital LOS (p = 0.002 and 0.011 respectively). Only age, disease and disease status predicted disease-free survival (DFS) and overall survival (OS) in our cohort (p < 0.005). Non-relapse mortality was not affected by low dose of CD34(+) (<2 × 10(6)/kg). In conclusion, our study shows that CD34(+) remains a useful and convenient marker for assessing haemotopoietic stem cell content and overall engraftment capacity post-transplant. Neutrophil contamination of HPC-A appears to be a key factor delaying neutrophil recovery. Steps to minimize the degree of neutrophil contamination in HPC-A product may be associated with more rapid neutrophil engraftment and reduced hospital LOS.
自体移植后的植入结果与输注的干细胞数量相关性较差。我们评估了2001年至2012年间在我们中心接受自体移植的446例连续患者。评估了移植前和采集因素以及CD34(+)剂量范围对植入、住院时间（LOS）和生存终点的影响，以确定哪些因素可以优化，以改善接受造血祖细胞单采术（HPC-A）进行自体移植患者的结局。输注的CD34(+)细胞剂量与血小板恢复相关，但与中性粒细胞恢复无关。接受低剂量CD34(+)与中高剂量CD34(+)的患者相比，血小板植入时间明显延迟。未缓解状态与中性粒细胞和血小板恢复较慢有关。HPC-A中中性粒细胞污染增加与中性粒细胞恢复较慢密切相关，输注的中性粒细胞剂量/千克受者体重≥3×10(8)/千克对中性粒细胞植入时间有显著影响（p = 0.001）。HPC-A中较高的中性粒细胞剂量/千克与粒细胞集落刺激因子（G-CSF）使用天数、HPC-A体积>500 ml以及HPC-A中较高的中性粒细胞计数（NCC）有关。高输注中性粒细胞剂量/千克和年龄>65岁与较长的住院LOS相关（分别为p = 0.002和0.011）。在我们的队列中，只有年龄、疾病和疾病状态可预测无病生存期（DFS）和总生存期（OS）（p < 0.005）。低剂量CD34(+)(<2×10(6)/千克)对非复发死亡率无影响。总之，我们的研究表明，CD34(+)仍然是评估移植后造血干细胞含量和总体植入能力的有用且方便的标志物。HPC-A中的中性粒细胞污染似乎是延迟中性粒细胞恢复的关键因素。尽量减少HPC-A产品中中性粒细胞污染程度的措施可能与更快的中性粒细胞植入和缩短住院LOS相关。
