Mainardi Chiara, Ebinger Martin, Enkel Sigrid, Feuchtinger Tobias, Teltschik Heiko-Manuel, Eyrich Matthias, Schumm Michael, Rabsteyn Armin, Schlegel Patrick, Seitz Christian, Schwarze Carl-Phillip, Müller Ingo, Greil Johann, Bader Peter, Schlegel Paul-Gerhardt, Martin David, Holzer Ursula, Döring Michaela, Handgretinger Rupert, Lang Peter
Department of Paediatric Oncology, Children's University Hospital, University of Padova, Padova, Italy.
Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany.
Br J Haematol. 2018 Jan;180(1):90-99. doi: 10.1111/bjh.15012. Epub 2017 Dec 3.
Poor graft function (PGF) is a severe complication of haematopoietic stem cell transplantation (HSCT) and administration of donor stem cell boosts (SCBs) represents a therapeutic option. We report 50 paediatric patients with PGF who received 61 boosts with CD34 selected peripheral blood stem cells (PBSC) after transplantation from matched unrelated (n = 25) or mismatched related (n = 25) donors. Within 8 weeks, a significant increase in median neutrophil counts (0·6 vs. 1·516 × 10 /l, P < 0·05) and a decrease in red blood cell and platelet transfusion requirement (median frequencies 1 and 7 vs. 0, P < 0·0001 and <0·001), were observed, and 78·8% of patients resolved one or two of their cytopenias. 36·5% had a complete haematological response. Median lymphocyte counts for CD3 , CD3 CD4 , CD19 and CD56 increased 8·3-, 14·2-, 22.- and 1·6-fold. The rate of de novo acute graft-versus-host disease (GvHD) grade I-III was only 6% and resolved completely. No GvHD grade IV or chronic GvHD occurred. Patients who responded to SCB displayed a trend toward better overall survival (OS) (P = 0·07). Thus, administration of CD34 selected SCBs from alternative donors is safe and effective. Further studies are warranted to clarify the impact on immune reconstitution and survival.
移植功能不良（PGF）是造血干细胞移植（HSCT）的一种严重并发症，给予供体干细胞增强治疗（SCBs）是一种治疗选择。我们报告了50例PGF儿科患者，他们在接受来自匹配无关供体（n = 25）或不匹配相关供体（n = 25）的移植后，接受了61次CD34选择的外周血干细胞（PBSC）增强治疗。在8周内，观察到中性粒细胞计数中位数显著增加（0·6对1·516×10⁹/l，P < 0·05），红细胞和血小板输注需求减少（中位数频率分别为1和7对0，P < 0·0001和<0·001），78·8%的患者一种或两种血细胞减少症得到缓解。36·5%的患者有完全血液学反应。CD3、CD3⁺CD4⁺、CD19和CD56的淋巴细胞计数中位数分别增加了8·3倍、14·2倍、22倍和1·6倍。新发急性移植物抗宿主病（GvHD）I - III级的发生率仅为6%且完全缓解。未发生IV级GvHD或慢性GvHD。对SCB有反应的患者总体生存率（OS）有改善趋势（P = 0·07）。因此，给予来自替代供体的CD34选择的SCBs是安全有效的。有必要进一步研究以阐明其对免疫重建和生存的影响。
