Faucher C, Le Corroller A G, Chabannon C, Viens P, Stoppa A M, Bouabdallah R, Camerlo J, Vey N, Gravis G, Gastaut J A, Novakovitch G, Mannoni P, Bardou V J, Moatti J P, Maraninchi D, Blaise D
Institut Paoli-Calmettes, Regional Cancer Research and Treatment Center, Marseille, France.
J Hematother. 1996 Dec;5(6):663-70. doi: 10.1089/scd.1.1996.5.663.
High-dose chemotherapy (HDC) supported by autologous transplantation of blood stem cells (BSC) is used increasingly for patients with poor-risk malignancies. We report our experience with 93 consecutive patients who were mobilized with recombinant human granulocyte colony-stimulating factor (rhG-CSF) alone. They received a fixed dose of G-CSF for 5 or 6 days, and BSC were collected by leukapheresis. Aphereses were evaluated for MNC, CD34+ cells, and CFU-GM counts and cryopreserved. All patients received a conditioning regimen without TBI. Engraftment was assessed as the first of 2 consecutive days on which patients achieved 0.5 and 1 x 10(9)/L neutrophils and an unsupported platelet count of 25 x 10(9)/L. Multivariate analysis was performed to study patients and graft characteristics that could influence reconstitution. The G-CSF priming regimen was well tolerated and allowed collection of BSC for all patients, 66% of them achieving >3 x 10(6)/kg CD34+ cells, and 86% achieving >10 x 10(4) CFU-GM/kg. The numbers of collected CD34 and CFU-GM cells were highly correlated. The number of courses of chemotherapy prior to collection, a diagnosis of breast cancer, the use of rhG-CSF posttransplant, and the numbers of CFU-GM and CD34+ cells reinfused were correlated with hematologic recovery. In a multivariate analysis, however, the number of CD34+ cells was the only factor independently influencing both granulocyte and platelet recovery. Patients who received at least 3 x 10(6)/kg CD34+ cells achieved granulocyte reconstitution on day 11 after reinfusion (range 8-15) and an unsupported platelet count of 25 x 10(9)/l on day 14 (range 12-180), significantly earlier than patients who received fewer cells (p < 0.001). In addition, G-CSF administration postreinfusion independently enhanced granulocyte reconstitution but not platelet recovery. In conclusion, CD34+ cell number appears to be the only factor predicting both granulocyte and platelet reconstitution. Based on this study, the collection of a minimal number of 3 x 10(6)/kg CD34+ cells appears desirable.
由自体血干细胞（BSC）移植支持的大剂量化疗（HDC）越来越多地用于高危恶性肿瘤患者。我们报告了连续93例仅用重组人粒细胞集落刺激因子（rhG-CSF）动员的患者的经验。他们接受固定剂量的G-CSF 5或6天，通过白细胞单采术采集BSC。对采集物进行单核细胞（MNC）、CD34+细胞和粒-巨噬细胞集落形成单位（CFU-GM）计数评估并冷冻保存。所有患者均接受了不含全身照射（TBI）的预处理方案。当患者连续2天中性粒细胞计数达到0.5和1×10⁹/L且血小板计数在无支持情况下达到25×10⁹/L时，评估为造血干细胞植入。进行多变量分析以研究可能影响造血重建的患者和移植物特征。G-CSF启动方案耐受性良好，所有患者均能采集到BSC，其中66%的患者获得>3×10⁶/kg CD34+细胞，86%的患者获得>10×10⁴ CFU-GM/kg。采集的CD34和CFU-GM细胞数量高度相关。采集前化疗疗程数、乳腺癌诊断、移植后rhG-CSF的使用以及回输的CFU-GM和CD34+细胞数量与血液学恢复相关。然而，在多变量分析中，CD34+细胞数量是唯一独立影响粒细胞和血小板恢复的因素。接受至少3×10⁶/kg CD34+细胞的患者在回输后第11天（范围8 - 15天）实现粒细胞重建，在第14天（范围12 - 180天）血小板计数在无支持情况下达到25×10⁹/L，明显早于接受细胞数量较少的患者（p < 0.001）。此外，回输后给予G-CSF独立增强了粒细胞重建，但未促进血小板恢复。总之，CD34+细胞数量似乎是预测粒细胞和血小板重建的唯一因素。基于本研究，采集至少3×10⁶/kg CD34+细胞似乎是可取的。
