Dicke K A, Hood D, Hanks S
Arlington Cancer Center, TX 76012.
J Hematother. 1994 Summer;3(2):141-4. doi: 10.1089/scd.1.1994.3.141.
Peripheral blood has become an alternative to bone marrow as a source of stem cells for transplantation. One of the major disadvantages of peripheral blood as a source is the low concentration of stem cells. For successful engraftment, the infusion of at least 6 x 10(8) nucleated cells per kg is required, a cell number obtained by 6-8 cell pheresis sessions. This cell number contains approximately 0.1% CD34 cells equivalent to 600,000 CD34 cells. It is known that chemotherapy and hematopoietic growth factors increase the concentration and total number of progenitor cells in the peripheral blood. In breast and lung cancer patients we are using two cytoreductive regimens: cytoxan 2 g/m2 + platinol 90 mg/m2, and VP-16 600-900 mg/m2+ platinol 90 mg/m2, respectively, in conjunction with G-CSF for stem cell mobilization. At the time of hematopoietic recovery, between day 13 and 16, the absolute number of CD34+ cells increases in 75% of the patients more than 20-fold, from 5,000 to at least 100,000/ml blood, and to more than 40-fold, to 200,000/ml, in 54% of the patients. Therefore, 3.4-7.5 ml blood contains up to 750,000 CD34+ cells, the minimum number of CD34 cells/kg body weight infused when steady-state collected peripheral blood cells are used. Since we use a minimum of 3 x 10(6) CD34+ cells/kg body weight, 15,000 ml of mobilized blood are required. This amount can often be obtained by collecting 500 ml blood by phlebotomy in 2-3 separate sessions, which is an easy and cost-effective method for the patient.
外周血已成为骨髓的替代物，作为移植用干细胞的来源。外周血作为来源的一个主要缺点是干细胞浓度低。为实现成功植入，每千克体重至少需要输注6×10⁸个有核细胞，这个细胞数量需通过6至8次细胞单采获得。这个细胞数量包含约0.1%的CD34细胞，相当于600,000个CD34细胞。已知化疗和造血生长因子可增加外周血中祖细胞的浓度和总数。在乳腺癌和肺癌患者中，我们正在使用两种细胞减灭方案：分别是环磷酰胺2 g/m² + 顺铂90 mg/m²，以及依托泊苷600 - 900 mg/m² + 顺铂90 mg/m²，并联合使用粒细胞集落刺激因子进行干细胞动员。在造血恢复时，即第13至16天，75%的患者CD34⁺细胞绝对数量增加超过20倍，从每毫升血液5,000个增加到至少100,000个，54%的患者增加超过40倍，达到每毫升200,000个。因此，3.4至7.5毫升血液含有多达750,000个CD34⁺细胞，这是使用稳态采集的外周血细胞时每千克体重输注的CD34细胞的最少数量。由于我们使用每千克体重至少3×10⁶个CD34⁺细胞，所以需要15,000毫升动员后的血液。这个量通常可以通过在2至3个单独的采血过程中每次采集500毫升血液获得，这对患者来说是一种简单且经济有效的方法。
