Demuynck H, Delforge M, Zachée P, Verhoef G E, Vandenberghe P, Boogaerts M A
Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
Ann Hematol. 1995 Jul;71(1):29-33. doi: 10.1007/BF01696229.
High-dose therapy with stem cell rescue is increasingly being used as a salvage or consolidation therapy for patients with poor-risk malignant disease. The availability of peripheral blood progenitor cells (PBPC) has opened new therapeutic perspectives to alleviate the severe toxicity related to prolonged myelo-suppression. The preferred method of collection is still a matter of much debate. PBPC can be collected in steady state and after chemotherapeutic conditioning, growth factor priming, or both. Usually a heterogeneous population containing both committed progenitors and pluripotent stem cells can be harvested. Studies comparing engraftment after mobilized PBPC with recovery after autologous bone marrow transplantation confirm the beneficial effect on neutrophil and platelet engraftment. The accelerated hematological recovery can be associated with a number of clinical benefits including a reduction of platelet transfusions and shorter hospital stay. Only a few randomized studies are currently available on the long-term outcome after PBPC transplantation. Recent findings on tumor cell mobilization stimulated the development of techniques for tumor cell reduction, based on negative selection ("purging") of tumor cells or positive selection of CD34-positive progenitor cells. Positive CD34 selection is also imperative for successful ex vivo expansion of progenitor cells and gene transfer experiments. The value of PBPC in the field of allogeneic transplantation is currently being examined.
大剂量疗法联合干细胞救援越来越多地被用作高危恶性疾病患者的挽救或巩固治疗。外周血祖细胞（PBPC）的可用性为减轻与长期骨髓抑制相关的严重毒性开辟了新的治疗前景。首选的采集方法仍然存在很多争议。PBPC可以在稳态下采集，也可以在化疗预处理、生长因子启动或两者兼有的情况下采集。通常可以收获一个包含定向祖细胞和多能干细胞的异质群体。比较动员后PBPC植入与自体骨髓移植后恢复情况的研究证实了其对中性粒细胞和血小板植入的有益作用。血液学恢复加速可带来许多临床益处，包括减少血小板输注和缩短住院时间。目前关于PBPC移植后长期结果的随机研究只有少数。最近关于肿瘤细胞动员的发现推动了基于肿瘤细胞阴性选择（“清除”）或CD34阳性祖细胞阳性选择的肿瘤细胞减少技术的发展。阳性CD34选择对于祖细胞的成功体外扩增和基因转移实验也是必不可少的。PBPC在异基因移植领域的价值目前正在研究中。
