Division of Hematology and Oncology, Toyohashi Municipal Hospital, Japan.
Division of Clinical Laboratory, Toyohashi Municipal Hospital, Japan.
Intern Med. 2024 Jan 15;63(2):189-195. doi: 10.2169/internalmedicine.1697-23. Epub 2023 May 24.
Objective Several institutions outsource CD34 cell counting of leukapheresis products, limiting rapid measurements, as results are obtained the next day. This problem is compounded with plerixafor use, a stem cell-mobilizing drug that increases leukapheresis efficiency but requires administration the day before leukapheresis. Use of this drug for a second leukapheresis procedure before the first-day leukapheresis CD34 count results are confirmed causes unnecessary leukapheresis and expensive plerixafor administration. We investigated whether or not measuring hematopoietic progenitor cells in leukapheresis products (AP-HPCs) using a Sysmex XN-series analyzer could resolve this problem. Methods We retrospectively compared the absolute AP-HPC value per body weight with the CD34 (AP-CD34) count in 96 first-day leukapheresis product samples obtained between September 2013 and January 2021. Comparisons were also conducted according to regimen: granulocyte colony-stimulating factor (G-CSF) monotherapy, chemotherapy plus G-CSF, or plerixafor mobilization. Results AP-CD34 and AP-HPC counts correlated strongly (r=0.846) overall and, in particular, under chemotherapy plus G-CSF (r=0.92) but correlated mildly under G-CSF monotherapy (r=0.655). AP-HPCs could not completely be dichotomized based on an AP-CD34 threshold of 2×10/kg for any stimulation procedure. In most cases with AP-HPCs >6×10/kg, the AP-CD34 count exceeded 2.0×10/kg, but in 5.7% of these cases, the AP-CD34 count was <2.0×10/kg. A cut-off of AP-HPCs >4.843×10/kg yielded a sensitivity of 71% and specificity of 96% for predicting AP-CD34≥2×10/kg. Conclusion AP-HPCs can identify cases in which sufficient stem cells have been collected.
目的 由于某些机构将白细胞分离产物的 CD34 细胞计数外包出去，导致结果需要第二天才能获得，从而限制了快速检测，这一问题在使用动员干细胞药物plerixafor 时更加严重，因为它会增加白细胞分离的效率，但需要在前一天给药。在获得第一次白细胞分离 CD34 计数结果之前，在第二天进行第二次白细胞分离程序时使用该药会导致不必要的白细胞分离和昂贵的 plerixafor 给药。我们研究了使用希森美康 XN 系列分析仪测量白细胞分离产物中的造血祖细胞 (AP-HPC) 是否可以解决此问题。
方法 我们回顾性比较了 2013 年 9 月至 2021 年 1 月期间 96 例第一次白细胞分离产物样本的每个体重的绝对 AP-HPC 值与 CD34（AP-CD34）计数。比较还根据方案进行：粒细胞集落刺激因子（G-CSF）单药治疗、化疗加 G-CSF 或 plerixafor 动员。
结果 AP-CD34 和 AP-HPC 计数总体上高度相关（r=0.846），尤其是在化疗加 G-CSF 时（r=0.92），但在 G-CSF 单药治疗时轻度相关（r=0.655）。对于任何刺激程序，AP-HPC 不能完全根据 AP-CD34 阈值 2×10/kg 进行二分。在大多数 AP-HPCs>6×10/kg 的情况下，AP-CD34 计数超过 2.0×10/kg，但在这些情况下的 5.7%，AP-CD34 计数<2.0×10/kg。AP-HPCs>4.843×10/kg 的截止值可使预测 AP-CD34≥2×10/kg 的灵敏度达到 71%，特异性达到 96%。
结论 AP-HPC 可以识别已经采集到足够干细胞的情况。
