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[儿童自体外周血干细胞移植]

[Autologous peripheral stem cell transplantation in children].

作者信息

Emminger W, Emminger-Schmidmeier W, Höcker P, Hawliczek R, Peters C, Pawlowsky J, Neuwirth G, Kummer M, Gadner H

机构信息

St. Anna Kinderspital, Wien.

出版信息

Klin Padiatr. 1989 Jul-Aug;201(4):299-303. doi: 10.1055/s-2008-1026718.

Abstract

19 children between 3 and 23 years underwent 79 leukapheres for collection of blood stem cells. In children suffering from acute lymphoblastic leukemia (ALL), Non Hodgkin's Lymphoma (NHL) and Ewing's Sarcoma (ES) we collected 6.87 x 10(4) CFU-GM/kg (range 2,65-21.7), if collections were started with the first platelet rise. In children with peripheral primitive neuroectodermal tumors (PNET) and neuroblastoma (NBL) we gained only 1.20 x 10(4) CFU-GM/kg (range 0.09-2.24). 17 children received high dose chemoradiotherapy and peripheral stem cell +/- bone marrow rescue. 9 suffered from solid tumors, 8 from hematopoietic malignancies. 9 were transfused with peripheral stem cells only, 8 received bone marrow in addition. Time to reach 0.5 x 10(9)/l granulocytes was very short-median 31 days (12-65), in 4 children receiving more than 5 x 10(4) CFU-GM/kg 12 to 13 days, only. On January 31st, 1989 6/17 children are alive in complete remission after a median observation time of 14.5 months (3-26) after autologous stem cell transfusion, one child is alive in "no remission", 7 died with relapse, 3 died because of infections (2 x aspergillosis, 1 x pseudomonas septicemia). The collection of blood derived stem cells by leukaphereses was well tolerated even in very small children and easily repeatable. With optimal timing high stem cell numbers were obtainable, resulting in a very short duration of posttransplant granulocytopenia.

摘要

19名3至23岁的儿童接受了79次白细胞分离术以采集造血干细胞。在患有急性淋巴细胞白血病(ALL)、非霍奇金淋巴瘤(NHL)和尤因肉瘤(ES)的儿童中,如果在首次血小板上升时开始采集,我们采集到了6.87×10⁴集落形成单位-粒细胞/千克(范围为2.65 - 21.7)。在患有外周原始神经外胚层肿瘤(PNET)和神经母细胞瘤(NBL)的儿童中,我们仅采集到1.20×10⁴集落形成单位-粒细胞/千克(范围为0.09 - 2.24)。17名儿童接受了大剂量放化疗及外周干细胞±骨髓救援。9名患有实体瘤,8名患有造血系统恶性肿瘤。9名仅输注了外周干细胞,8名还接受了骨髓输注。达到0.5×10⁹/升粒细胞的时间非常短——中位时间为31天(12 - 65天),4名接受超过5×10⁴集落形成单位-粒细胞/千克的儿童仅需12至13天。1989年1月31日,17名儿童中有6名在自体干细胞输注后经过中位观察时间14.5个月(3 - 26个月)处于完全缓解状态存活,1名儿童存活但“未缓解”,7名死于复发,3名死于感染(2例曲霉菌病,1例铜绿假单胞菌败血症)。即使对于非常小的儿童,通过白细胞分离术采集血液来源的干细胞耐受性良好且易于重复。在最佳时机可获得高数量的干细胞,从而使移植后粒细胞减少的持续时间非常短。

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