Arseniev L, Tischler H J, Battmer K, Südmeier I, Casper J, Link H
Department of Hematology and Oncology, Medizinische Hochschule Hannover, Germany.
Bone Marrow Transplant. 1994 Nov;14(5):791-7.
The treatment effect of immunoselected allogeneic CD34+ blood cells was evaluated in two patients with poor graft function following BMT without evidence for immune-mediated rejection. Patient A had no signs of hematopoietic recovery up to day +34 post-BMT and patient B had normal leukocyte counts only with G-CSF support and remained platelet transfusion-dependent for > 200 days post-BMT. PBPC from the HLA-identical sibling BM donors were mobilized with G-CSF (2 x 5 micrograms/kg sc daily) for 5 days. Aphereses were performed on days 4 and 5 of G-CSF administration. CD34+ cells were separated from the pooled PBPC concentrates by immunoadsorption with the anti-CD34 moAb 12.8 in a biotin-avidin system. Patient A received 0.4 x 10(6) CD34+ and 4.3 x 10(5) CD3+ cells/kg body weight and patient B 3.4 x 10(6) CD34+ and 1.4 x 10(5) CD3+ cells/kg body weight. The trilineage repopulation of BM and the rapid improvement of peripheral blood parameters correlated with CD34+ cell infusion. Patients' blood and BM cell analyses proved the donor origin. Patient A died from CMV pneumonitis and multiorgan failure 27 days after CD34+ cell infusion (day +61 post-BMT). Patient B is still stable and in remission 260 days after CD34+ cell infusion (day +478 post-BMT). Neither patient suffered further exacerbation of GVHD). Thus, immunoselected allogeneic CD34+ blood cells might be appropriate for treatment of post-BMT graft failure.
在两名异基因骨髓移植（BMT）后移植物功能不良且无免疫介导排斥证据的患者中评估了免疫选择的同种异体CD34 +血细胞的治疗效果。患者A在BMT后第34天仍无造血恢复迹象，患者B仅在粒细胞集落刺激因子（G-CSF）支持下白细胞计数正常，且在BMT后200多天仍依赖血小板输注。来自HLA相同同胞骨髓供体的外周血祖细胞（PBPC）用G-CSF（2×5微克/千克皮下注射，每日一次）动员5天。在G-CSF给药的第4天和第5天进行单采。通过在生物素-抗生物素蛋白系统中用抗CD34单克隆抗体12.8进行免疫吸附，从汇集的PBPC浓缩物中分离出CD34 +细胞。患者A接受了0.4×10⁶个CD34 +细胞和4.3×10⁵个CD3 +细胞/千克体重，患者B接受了3.4×10⁶个CD34 +细胞和1.4×10⁵个CD3 +细胞/千克体重。骨髓的三系造血重建和外周血参数的快速改善与CD34 +细胞输注相关。患者血液和骨髓细胞分析证实了供体来源。患者A在CD34 +细胞输注后27天（BMT后第61天）死于巨细胞病毒肺炎和多器官功能衰竭。患者B在CD34 +细胞输注后260天（BMT后第478天）仍病情稳定且处于缓解状态。两名患者均未出现移植物抗宿主病（GVHD）的进一步加重。因此，免疫选择的同种异体CD34 +血细胞可能适用于治疗BMT后的移植物失败。
