Watanabe S, Mukaiyama T, Ogawa Y, Kawada H, Ichikawa Y
Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Tokai J Exp Clin Med. 1994 Dec;19(3-6):143-55.
Peripheral blood stem cell (PBSC) transplantation (PBSCT) following high-dose chemotherapy is considered to be an effective and curative strategy for patients with certain malignancies. Optimal conditions for collection of PBSC and successful PBSCT, however, are still controversial. We performed 57 leukaphereses after 19 courses of chemotherapy for mobilization of PBSC (semi-high-dose VP-16 alone; 500 mg/m2/day for 3 or 4 days, 13 courses, or conventional chemotherapy; six courses) combined with subsequent G-CSF administration in 13 patients with malignancies (six with lymphoma, five with leukemia, and two with germ cell tumors). Total numbers of the CD34+ cells and CFU-GM obtained by multiple leukaphereses after one course of mobilization therapy were 0.63-168.74 x 10(6)/kg (mean 33.94) and 0.15-56.0 x 10(5)/kg (mean 8.22), respectively. We demonstrated that many cellular components of peripheral blood (PB) on the day of PBSC harvest, especially CD34+ cell, total leukocyte, myelocyte and monocyte counts, were correlated with the numbers of CFU-GM obtained in each leukapheresis. A daily increase of leukocyte counts was another useful indicator for the day of PBSC harvest. We also found that the time when total leukocyte counts in PB recovered to more than 5000/microliters or when CD34+ cells within PB mononuclear cells exceeded 1% was optimal for PBSC harvest. Our results confirmed that the semi-high-dose regimen with VP-16 combined with G-CSF is a safe method which has both antitumor effects and mobilization ability of PBSC in patients with hematological malignancies. PBSCT following various high-dose chemotherapy regimens with or without total body irradiation was also performed in 11 of the 13 patients, and rapid hematologic recovery was observed in all of the patients.
大剂量化疗后进行外周血干细胞（PBSC）移植（PBSCT）被认为是某些恶性肿瘤患者的一种有效且可治愈的策略。然而，PBSC采集的最佳条件和PBSCT的成功仍存在争议。我们对13例恶性肿瘤患者（6例淋巴瘤、5例白血病和2例生殖细胞肿瘤）进行了19个疗程的化疗后进行了57次白细胞分离术，以动员PBSC（单独使用半大剂量VP - 16；500mg/m²/天，共3或4天，13个疗程，或传统化疗；6个疗程），并随后给予G - CSF。一个疗程动员治疗后通过多次白细胞分离术获得的CD34⁺细胞总数和CFU - GM分别为0.63 - 168.74×10⁶/kg（平均33.94）和0.15 - 56.0×10⁵/kg（平均8.22）。我们证明，PBSC采集当天外周血（PB）的许多细胞成分，特别是CD34⁺细胞、总白细胞、髓细胞和单核细胞计数，与每次白细胞分离术中获得的CFU - GM数量相关。白细胞计数的每日增加是PBSC采集日期的另一个有用指标。我们还发现，PB中总白细胞计数恢复到超过5000/微升或PB单核细胞内CD34⁺细胞超过1%的时间是PBSC采集的最佳时间。我们的结果证实，VP - 16联合G - CSF的半大剂量方案是一种安全的方法，对血液系统恶性肿瘤患者既有抗肿瘤作用又有PBSC动员能力。13例患者中的11例还接受了各种有或无全身照射的大剂量化疗方案后的PBSCT，所有患者均观察到快速的血液学恢复。
