Murea S, Goldschmidt H, Hahn U, Pförsich M, Moos M, Haas R
Department of Internal Medicine V, University of Heidelberg, Germany.
J Clin Apher. 1996;11(4):185-94. doi: 10.1002/(SICI)1098-1101(1996)11:4<185::AID-JCA3>3.0.CO;2-7.
It was the aim of our study to determine the collection efficiency and yield of CD34+ cells in 88 cancer patients (pts, 44 males/44 females) who underwent 154 large-volume leukaphereses (LV-LPs). The diagnoses were as follows: 18 patients had Non-Hodgkin's lymphoma, 9 Hodgkin's disease, 24 multiple myeloma, 6 acute leukemia, 27 breast cancer, and 4 patients had solid tumors of different types. During the course of LV-LPs, 20 liters (1) of blood were processed at a median flow-rate of 85 ml/min (CS 3000 Baxter) and 130 ml/min (COBE Spectra), respectively. Peripheral blood stem cells (PBSC) were collected following granulocyte colony-stimulating factor (G-CSF)-supported cytotoxic chemotherapy. A 31% and 21% mean decrease in the platelet and white blood count was noted at the end of the LV-LPs when compared with the pre-leukapheresis values. The aphereses were well tolerated without adverse effects. The level of circulating CD34+ cells was closely related to the number of CD34+ cells contained in the respective leukapheresis product (R = 0.89, P < 0.001). Compared with 270 patients who underwent 838 regular 10 1 LPs, the yield of CD34+ cells/kg was almost two-fold greater (4.84 +/- 0.63 x 10(6) [Mean +/- SEM] vs. 2.60 +/- 0.16 x 10(6), P < 0.001). The antigenic profile of CD34+ cells was assessed in 54 separate products collected on the occasion of 27 LV-LPs following the processing of 10 1 and 20 1, respectively. The intra-individual comparison included differentiation- as well as lineage-associated markers (CD38, Thy-1, c-kit, CD33, CD45RA). No difference in the subset composition was observed between the first and second product, arguing against a preferential release of particular CD34+ cell subsets during the procedure. As shown by molecular biological or immunocytochemical examination, the likelihood of harvesting malignant cells using large-volume aphereses was not increased in comparison with regular leukaphereses. Single harvests of > or = 2.5 x 10(6) CD34+ cells/kg could be obtained in 74% of the patients, compared with 52% in case of regular LPs. As the majority of patients were autografted with more than 2.5 x 10(6) CD34+ cells/kg following high-dose therapy, hematological recovery in general was rapid and not related to the type of apheresis product used. Considering patient comfort and savings in resource utilization, large-volume leukaphereses have become the standard procedure for PBSC collection in our center.
我们的研究目的是确定88例癌症患者（44例男性/44例女性）在接受154次大容量白细胞单采术（LV-LP）时CD34+细胞的采集效率和产量。诊断情况如下：18例患者患有非霍奇金淋巴瘤，9例患有霍奇金病，24例患有多发性骨髓瘤，6例患有急性白血病，27例患有乳腺癌，4例患有不同类型的实体瘤。在LV-LP过程中，分别以85 ml/min（Baxter CS 3000）和130 ml/min（COBE Spectra）的中位流速处理20升血液。在粒细胞集落刺激因子（G-CSF）支持的细胞毒性化疗后采集外周血干细胞（PBSC）。与白细胞单采术前的值相比，LV-LP结束时血小板和白细胞计数平均分别下降了31%和21%。白细胞单采术耐受性良好，无不良反应。循环CD34+细胞水平与相应白细胞单采产物中所含CD34+细胞数量密切相关（R = 0.89，P < 0.001）。与270例接受838次常规10 L白细胞单采术的患者相比，CD34+细胞/kg产量几乎高出一倍（4.84 +/- 0.63 x 10(6) [平均值 +/- 标准误] 对 2.60 +/- 0.16 x 10(6)，P < 0.001）。在分别处理10 L和20 L血液后，于27次LV-LP时采集的54份单独产物中评估了CD34+细胞的抗原谱。个体内比较包括分化相关和谱系相关标志物（CD38、Thy-1、c-kit、CD33、CD45RA）。在第一个和第二个产物之间未观察到亚群组成的差异，这表明在该过程中没有特定CD34+细胞亚群的优先释放。分子生物学或免疫细胞化学检查表明，与常规白细胞单采术相比，使用大容量白细胞单采术采集恶性细胞的可能性并未增加。74%的患者单次采集可获得≥2.5 x 10(6) CD34+细胞/kg，而常规白细胞单采术的这一比例为52%。由于大多数患者在大剂量治疗后接受了超过2.5 x 10(6) CD34+细胞/kg的自体移植，总体血液学恢复迅速，且与所使用的白细胞单采产物类型无关。考虑到患者的舒适度和资源利用的节省，大容量白细胞单采术已成为我们中心采集PBSC的标准程序。
