Körbling M, Chan K W, Anderlini P, Seong D, Durett A, Langlinais A, Przepiorka D, Gajewski J, Miller P, Sundberg J, Alilaen P, Bojko P, Mirza N, Claxton D, van Besien K, Khouri I, Andersson B, Mehra R, Champlin R
Department of Hematology and Pediatrics, University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Bone Marrow Transplant. 1996 Nov;18(5):885-90.
Successful allogeneic peripheral blood progenitor cell (PBPC) transplantation has recently been reported by several transplant centers. This is a first report describing allogeneic PBPC transplantation in five patients using related pediatric donors between the ages of 4 and 13 years. Donors underwent 3 or 4 days of rhG-CSF treatment (6 micrograms/kg q 12 h) for stem cell peripheralization prior to PBPC collection, which was performed by continuous-flow apheresis on day 4 or 5. Venous access was exclusively by ante-cubital veins. A median of 2.2 times (range 1.4-3.6) the donor's total blood volume (TBV) was processed per procedure. In cases where the donor's TBV was < 2 liters, the blood cell separator was primed with human serum albumin (HSA-5%), and anticoagulation was performed using a combination of heparin (pre-apheresis bolus + continuous infusion (CI)) and/or ACD-A (CI at a reduced rate). The median number of CD34+ cells collected per kg of donor body weight (b.w.) and per liter of donor blood processed during each procedure was 128 x 10(4) (range 58 x 10(4)-314 x 10(4)). Between one and two aphereses were sufficient to collect a safe CD34+ cell engraftment dose of 3 or 4 x 10(6)/kg of recipient b.w. Two PBPC recipients were parents, and three were siblings. After freezing and thawing, the median number of CD34+ cells per kg of recipient b.w. thawed and transfused was 8.5 x 10(6) (range 3.2 x 10(6)-9.7 x 10(6)). The time to PMN > 1000/microliters was between 10 and 16 days (four out of five evaluable patients), and platelets > 20000/microliters were reached between day 13 and 14 post-transplantation (three out of five evaluable patients). Two out of three evaluable patients developed grades one and three acute GVHD, and one out of three developed chronic GVHD. Two patients died of sepsis and VOD at day 10 and 19, respectively. Two adult patients are alive and in cytogenetic and molecular remission of CML at +339 and +227 days post-allotransplantation. One 3-year-old girl with hemophagocytic lymphohistiocytosis is in remission at +304 days post-transplantation. Using pediatric donors for allogeneic PBPC transplantation appears to be safe, yields a sufficient amount of progenitors for prompt engraftment, and results in clinical outcome similar to adult PBPC allotransplantation.
最近，几个移植中心报告了异基因外周血祖细胞（PBPC）移植成功的案例。本文首次报道了5例使用4至13岁相关儿童供者进行异基因PBPC移植的情况。在采集PBPC之前，供者接受3或4天的重组人粒细胞集落刺激因子（rhG-CSF）治疗（6微克/千克，每12小时一次），以促使干细胞向外周血迁移，于第4或5天通过连续流动单采术采集PBPC。静脉通路均采用肘前静脉。每次操作处理的血量中位数为供者总血容量（TBV）的2.2倍（范围1.4 - 3.6倍）。若供者TBV < 2升，则血细胞分离机用5%人血清白蛋白（HSA）预充，并联合使用肝素（单采前推注 + 持续输注（CI））和/或ACD - A（以较低速率CI）进行抗凝。每次操作每千克供者体重（b.w.）和每升供者血液采集的CD34 + 细胞中位数为128×10⁴（范围58×10⁴ - 314×10⁴）。一至两次单采就足以采集到安全的CD34 + 细胞植入剂量，即3或4×10⁶/千克受者b.w.。两名PBPC受者为父母，三名是兄弟姐妹。冻融后，每千克受者b.w.解冻并输注的CD34 + 细胞中位数为8.5×10⁶（范围3.2×10⁶ - 9.7×10⁶）。中性粒细胞计数>1000/微升的时间为10至16天（5例可评估患者中的4例），血小板计数>20000/微升在移植后第13至14天达到（5例可评估患者中的3例）。3例可评估患者中有2例发生了1级和3级急性移植物抗宿主病（GVHD），3例中有1例发生了慢性GVHD。两名患者分别于第10天和第19天死于败血症和肝静脉闭塞病（VOD）。两名成年患者存活，在异基因移植后第339天和第227天处于慢性粒细胞白血病（CML）的细胞遗传学和分子学缓解状态。一名3岁患噬血细胞性淋巴组织细胞增生症的女孩在移植后第304天处于缓解状态。使用儿童供者进行异基因PBPC移植似乎是安全的，能产生足够数量的祖细胞以促进快速植入，且临床结果与成人PBPC异基因移植相似。
