Watts M J, Sullivan A M, Jamieson E, Pearce R, Fielding A, Devereux S, Goldstone A H, Linch D C
Department of Haematology, University College London Medical School, United Kingdom.
J Clin Oncol. 1997 Feb;15(2):535-46. doi: 10.1200/JCO.1997.15.2.535.
To define parameters that predict for rapid engraftment after peripheral-blood stem-cell (PBSC) transplantation, progenitor thresholds, the proportion of patients who achieve these thresholds with a standardized mobilization regimen, and the factors that predict for mobilization efficiency.
One hundred and one patients with pretreated lymphoma were mobilized with cyclophosphamide 1.5 g/m2 and granulocyte colony-stimulating factor (G-CSF), with the first apheresis performed when the recovery WBC count was > or = 5.0 x 10(9)/L. The relationship between the number of progenitor cells collected and patient age, sex, diagnosis, prior radiotherapy, and time since last chemotherapy was determined by multivariate analysis. The relationship between these factors, progenitor numbers returned, post-PBSC G-CSF, and hematologic recovery was performed in 81 patients following chemotherapy with carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM protocol).
No BEAM recipients had delayed neutrophil recovery beyond 28 days. Delayed platelet recovery occurred in 7.4% and minimum and optimum thresholds of 1 x 10(6) and 3.5 x 10(6) CD34+ cells/kg and 1 x 10(5) and 3.5 x 10(5) granulocyte-macrophage colony-forming cells (GM-CFC)/kg were established. Hematologic recovery was adversely affected by prior treatment with mini-BEAM, and neutrophil recovery was accelerated by post-PBSC G-CSF. The minimum GM-CFC threshold was achieved with a single apheresis in 83% of patients and in 90% with two aphereses. The optimal threshold was achieved with two leukaphereses in 69% of patients. Prior radiotherapy adversely affected mobilization.
Hematopoietic recovery following PBSC is dependent on progenitor-cell number infused and affect of previous chemotherapy on progenitor quality. Progenitor-cell mobilization is adversely affected by prior radiotherapy. The minimum threshold of GM-CFC required is achieved in most patients with a single apheresis, but an optimal collection usually requires at least two harvests.
确定预测外周血干细胞（PBSC）移植后快速植入的参数、祖细胞阈值、采用标准化动员方案达到这些阈值的患者比例以及预测动员效率的因素。
101例预处理淋巴瘤患者接受环磷酰胺1.5 g/m²和粒细胞集落刺激因子（G-CSF）动员，当白细胞恢复计数≥5.0×10⁹/L时进行首次单采。通过多因素分析确定采集的祖细胞数量与患者年龄、性别、诊断、既往放疗及末次化疗后时间的关系。在81例接受卡莫司汀（BCNU）、依托泊苷、阿糖胞苷和美法仑化疗（BEAM方案）后的患者中，分析这些因素、回输的祖细胞数量、PBSC后G-CSF与血液学恢复之间的关系。
接受BEAM方案的患者中性粒细胞恢复均未延迟超过28天。7.4%的患者出现血小板恢复延迟，确定了CD34⁺细胞/kg的最低和最佳阈值分别为1×10⁶和3.5×10⁶，粒细胞-巨噬细胞集落形成细胞（GM-CFC）/kg的最低和最佳阈值分别为1×10⁵和3.5×10⁵。既往接受mini-BEAM治疗对血液学恢复有不利影响，PBSC后G-CSF可加速中性粒细胞恢复。83%的患者单次单采可达到最低GM-CFC阈值，9%的患者两次单采可达到。69%的患者两次白细胞单采可达到最佳阈值。既往放疗对动员有不利影响。
PBSC移植后的造血恢复取决于输入的祖细胞数量以及既往化疗对祖细胞质量的影响。祖细胞动员受到既往放疗的不利影响。大多数患者单次单采可达到所需GM-CFC的最低阈值，但最佳采集通常至少需要两次收获。
