Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
Mailman School of Public Health, Columbia University, New York, New York.
Biol Blood Marrow Transplant. 2018 Feb;24(2):324-329. doi: 10.1016/j.bbmt.2017.10.031. Epub 2017 Oct 23.
To ensure optimal clinical outcomes for patients while retaining adequate protection for donors, the National Marrow Donor Program developed guidelines specifying that up to 20 mL/kg of bone marrow can be harvested from donors. These guidelines, originally developed for unrelated adult donors, are followed in children as well. We studied the impact of granulocyte colony-stimulating factor (G-CSF) priming on the cellular composition of harvested bone marrow, sought to develop an algorithm to optimize bone marrow harvest volume from pediatric matched sibling donors, and studied the impact of CD34 cell dose on clinical outcomes. We analyzed data from 92 bone marrow harvests and clinical outcomes for 69 sibling recipient-donor duos, The mean age of recipients was 9.85 ± 5.90 years, and that of donors was 11.85 ± 6.36 years. G-CSF priming was not associated with higher yield of CD34 cells/µL. The median CD34 cell count obtained from donors was 700 cells/µL (range, 400-1700 cells/µL) in donors age <6 years, 360 cells/µL (range, 100-1100 cells/µL) in donors age 6 to 12 years, and 300 cells/µL (range, 80-800 cells/µL) in donors age >12 years (P < .001). The number of CD34 cells infused had no impact on traditional clinical outcomes; however, it was significantly related to graft-versus-host disease/relapse/rejection-free survival. Our investigation revealed that ultimately, a CD34 cell count of approximately 3 to 5 × 10/kg was a threshold beyond which increasing CD34 cell dose did not impact outcome. In this study, we addressed the broad question of whether harvesting up to 20 mL/kg of bone marrow from a child donor is truly necessary for optimal outcomes in every pediatric case.
为了确保患者获得最佳临床结果，同时为供者提供充分保护，国家骨髓供者计划制定了指南，规定可以从供者中采集多达 20 毫升/公斤的骨髓。这些指南最初是为无关的成年供者制定的，在儿童中也得到了遵循。我们研究了粒细胞集落刺激因子（G-CSF）预处理对采集骨髓的细胞组成的影响，试图开发一种算法来优化儿童匹配同胞供者的骨髓采集量，并研究 CD34 细胞剂量对临床结果的影响。我们分析了 92 例骨髓采集和 69 对同胞受者-供者的数据，受者的平均年龄为 9.85±5.90 岁，供者的平均年龄为 11.85±6.36 岁。G-CSF 预处理与 CD34 细胞/µL 的更高产量无关。<6 岁的供者中获得的中位数 CD34 细胞计数为 700 细胞/µL（范围，400-1700 细胞/µL），6-12 岁的供者中为 360 细胞/µL（范围，100-1100 细胞/µL），>12 岁的供者中为 300 细胞/µL（范围，80-800 细胞/µL）（P<.001）。输注的 CD34 细胞数量对传统的临床结果没有影响；然而，它与移植物抗宿主病/复发/排斥反应无事件生存显著相关。我们的研究表明，最终，大约 3 到 5×10/kg 的 CD34 细胞计数是一个阈值，超过该阈值，增加 CD34 细胞剂量不会影响结果。在这项研究中，我们解决了一个广泛的问题，即从儿童供者中采集多达 20 毫升/公斤的骨髓是否真的是每个儿科病例获得最佳结果所必需的。
