Anderlini P, Przepiorka D, Seong D, Miller P, Sundberg J, Lichtiger B, Norfleet F, Chan K W, Champlin R, Körbling M
Section of Blood Transplantation, University of Texas, M.D. Anderson Cancer Center, Houston, USA.
Transfusion. 1996 Jul;36(7):590-5. doi: 10.1046/j.1537-2995.1996.36796323057.x.
Apheresis of granulocyte-colony-stimulating factor (filgrastim)-mobilized blood stem cells from normal donors is now being used in place of a marrow harvest in transplantation. How the adverse effects of and charges for this procedure compare with those of the standard marrow harvest is not known.
Forty consecutive normal subjects who received filgrastim 96 micrograms/kg) subcutaneously twice daily for 4 to 6 days in preparation for apheresis were monitored prospectively by clinical and laboratory evaluation.
Sixty-two percent of the subjects required oral analgesics. None discontinued filgrastim prematurely. Bone pain (82%), headache (70%), fatigue (20%), and nausea (10%) were reported. Filgrastim caused a mean eightfold increase in neutrophil counts, a mean twofold increase in lymphocyte counts, a mean twofold rise in alkaline phosphatase and lactate dehydrogenase levels, and minor changes in serum potassium, magnesium, and uric acid. Adverse events and laboratory effects resolved within 7 days after apheresis. No apheresis stem cell donor required transfusion or hospitalization, and only one required an additional clinic visit after completion of apheresis. By comparison, a retrospective analysis of 33 normal marrow donors demonstrated that all received transfusion(s), 3 were hospitalized, 3 required additional clinic visits after the marrow harvest. The median total charges related to the two procedures were comparable (p = 0.43), although the charges were significantly lower for donors requiring only one apheresis procedure (p = 0.002).
Filgrastim mobilization and apheresis of blood stem cells constitute a safe, well-tolerated, and comparable or less expensive alternative to the traditional marrow harvest.
目前，从正常供体中采集粒细胞集落刺激因子（非格司亭）动员的血液干细胞已被用于替代移植中的骨髓采集。该操作的不良反应和费用与标准骨髓采集相比如何尚不清楚。
连续40名正常受试者，为准备进行血细胞分离术，每天皮下注射非格司亭96微克/千克，持续4至6天，通过临床和实验室评估进行前瞻性监测。
62%的受试者需要口服镇痛药。无人提前停用非格司亭。报告有骨痛（82%）、头痛（70%）、疲劳（20%）和恶心（10%）。非格司亭使中性粒细胞计数平均增加8倍，淋巴细胞计数平均增加2倍，碱性磷酸酶和乳酸脱氢酶水平平均升高2倍，血清钾、镁和尿酸有轻微变化。血细胞分离术后7天内，不良事件和实验室检查结果均得到缓解。没有血细胞分离术干细胞供体需要输血或住院，只有1人在血细胞分离术完成后需要额外就诊。相比之下，对33名正常骨髓供体的回顾性分析表明，所有人都接受了输血，3人住院，3人在骨髓采集后需要额外就诊。两种操作的总费用中位数相当（p = 0.43），尽管仅需进行一次血细胞分离术的供体费用显著较低（p = 0.002）。
非格司亭动员和血细胞分离术采集血液干细胞是一种安全、耐受性良好且费用相当或更低的替代传统骨髓采集的方法。
