Farhadfar Nosha, Hsu Jack W, Logan Brent R, Sees Jennifer A, Chitphakdithai Pintip, Sugrue Michele W, Abdel-Azim Hisham, Anderlini Paolo N, Bredeson Christopher, Chhabra Saurabh, Diaz Miguel Angel, Ganguly Siddhartha, Hematti Peiman, Kamble Rammurti T, Kasow Kimberly A, Lazarus Hillard M, Lynch Debra Kelly, Murthy Hemant S, Olsson Richard F, Papari Mona, Przepiorka Donna, Savani Bipin N, Schears Raquel, Seo Sachiko, Solh Melhem M, Spitzer Thomas, Yared Jean A, Pulsipher Michael A, Shah Nirali N, Switzer Galen E, Confer Dennis L, Shaw Bronwen E, Wingard John R
Division of Hematology and Oncology, Department of Medicine, Shands HealthCare and University of Florida, Gainesville, FL.
Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, and.
Blood Adv. 2020 Feb 25;4(4):706-716. doi: 10.1182/bloodadvances.2019000923.
There are limited data on the effect of donor body mass index (BMI) on peripheral blood stem cell (PBSC) mobilization response to granulocyte colony-stimulating factor (G-CSF), especially in unrelated donors. Obesity has been associated with persistent leukocytosis, elevated circulating progenitor cells, and enhanced stem cell mobilization. Therefore, we hypothesized that adequate collection of CD34+ cells may be achieved with lower doses (per kilogram of body weight) of G-CSF in donors with higher BMI compared with donors with lower BMI. Using the Center for International Blood and Marrow Transplant Research database, we evaluated the impact of donor BMI on G-CSF-mobilized PBSC yield in healthy unrelated donors. We examined 20 884 PBSC donations collected at National Marrow Donor Program centers between 2006 and 2016. We found significantly higher collection yields in obese and severely obese donors compared with normal and overweight donors. An increase in average daily G-CSF dose was associated with an increase in stem cell yield in donors with normal or overweight BMI. In contrast, an increase in average daily G-CSF dose beyond 780 μg per day in obese and 900 μg per day in severely obese donors did not increase cell yield. Pain and toxicities were assessed at baseline, during G-CSF administration, and postcollection. Obesity was associated with higher levels of self-reported donation-related pain and toxicities in the pericollection and early postdonation recovery periods. This study suggests a maximum effective G-CSF dose for PBSC mobilization in obese and severely obese donors, beyond which higher doses of G-CSF add no increased yield.
关于供体体重指数（BMI）对粒细胞集落刺激因子（G-CSF）动员外周血干细胞（PBSC）反应的影响，尤其是在非亲缘供体中的数据有限。肥胖与持续性白细胞增多、循环祖细胞升高以及干细胞动员增强有关。因此，我们推测，与BMI较低的供体相比，BMI较高的供体使用较低剂量（每千克体重）的G-CSF可能就能实现足够数量的CD34+细胞采集。利用国际血液和骨髓移植研究中心数据库，我们评估了供体BMI对健康非亲缘供体中G-CSF动员的PBSC产量的影响。我们研究了2006年至2016年期间在国家骨髓捐献项目中心采集的20884例PBSC捐献。我们发现，肥胖和严重肥胖的供体与正常和超重的供体相比，采集产量显著更高。正常或超重BMI的供体中，平均每日G-CSF剂量的增加与干细胞产量的增加相关。相比之下，肥胖供体平均每日G-CSF剂量超过780μg/天以及严重肥胖供体超过900μg/天，细胞产量并未增加。在基线、G-CSF给药期间和采集后评估疼痛和毒性。肥胖与采集期间和捐献后早期恢复阶段自我报告的与捐献相关的疼痛和毒性水平较高有关。这项研究表明了肥胖和严重肥胖供体中用于PBSC动员的G-CSF最大有效剂量，超过该剂量，更高剂量的G-CSF不会增加产量。
