Miflin G, Russell N H, Hutchinson R M, Morgan G, Potter M, Pagliuca A, Marsh J, Bell A, Milligan D, Lumley M, Cook G, Franklin I
Department of Haematology, Nottingham City Hospital, UK.
Bone Marrow Transplant. 1997 Jan;19(1):9-13. doi: 10.1038/sj.bmt.1700603.
We have carried out an analysis of 44 patients undergoing allogeneic PBSC transplants from fully HLA-matched related donors with particular emphasis on engraftment kinetics and the incidence and severity of GVHD. The recipients had a median age of 37 years (range 5-56 years), 16 patients had standard-risk disease and 28 had poor-risk disease. GVHD prophylaxis was with cyclosporin A and methotrexate (n = 41), cyclosporin A alone (n = 2) or cyclosporin A and methyl-prednisolone (n = 1). Stem cells were mobilised using G-CSF, collecting a median of 5.75 x 10(6) CD34+ cells/kg recipient weight (range 0.94-35 x 10(6) CD34+ cells/kg). Engraftment times to a neutrophil count > 0.5 x 10(9)/1 and platelets > 20 x 10(9)/1 were achieved at a median of day +14 (range 10-25) and day +14 (range 9-130) respectively. Patients receiving > or = 4 x 10(6) CD34+ cells/kg had significantly accelerated neutrophil and platelet engraftment and this number of CD34+ cells would appear to be a prerequisite for maximum engraftment using PBSC. Acute GVHD occurred in 25 of 43 evaluable patients although in only 12 was this clinically significant (grades II-IV). Chronic GVHD has occurred in 17 out of 36 evaluable patients, there was no significant difference between the standard- and poor-risk groups in incidence of either acute or chronic GVHD. In conclusion, these results confirm the feasibility of using PBSC for allogeneic transplantation without evidence for increased risk of either acute or chronic GVHD and provide further evidence supporting the potential of PBSC to replace bone marrow as the major source of haemopoietic cells for allogeneic transplantation.
我们对44例接受来自HLA完全匹配的相关供者的异基因外周血干细胞移植的患者进行了分析，特别关注植入动力学以及移植物抗宿主病（GVHD）的发生率和严重程度。受者的中位年龄为37岁（范围5 - 56岁），16例患者患有标准风险疾病，28例患有高风险疾病。GVHD预防采用环孢素A和甲氨蝶呤（n = 41）、单独使用环孢素A（n = 2）或环孢素A和甲基泼尼松龙（n = 1）。使用粒细胞集落刺激因子（G - CSF）动员干细胞，收集的CD34 +细胞中位数为5.75×10⁶个/kg受者体重（范围0.94 - 35×10⁶个/kg）。中性粒细胞计数> 0.5×10⁹/L和血小板> 20×10⁹/L的植入时间中位数分别为第 + 14天（范围10 - 25天）和第 + 14天（范围9 - 130天）。接受≥4×10⁶个/kg CD34 +细胞的患者中性粒细胞和血小板植入明显加速，这个CD34 +细胞数量似乎是使用外周血干细胞实现最大植入的先决条件。43例可评估患者中有25例发生急性GVHD，不过只有12例具有临床意义（II - IV级）。36例可评估患者中有17例发生慢性GVHD，急性或慢性GVHD的发生率在标准风险组和高风险组之间无显著差异。总之，这些结果证实了使用外周血干细胞进行异基因移植的可行性，没有证据表明急性或慢性GVHD风险增加，并提供了进一步的证据支持外周血干细胞有可能取代骨髓作为异基因移植造血细胞的主要来源。
