Watts M J, Sullivan A M, Leverett D, Peniket A J, Perry A R, Williams C D, Devereux S, Goldstone A H, Linch D C
University College London Hospitals, United Kingdom.
J Clin Oncol. 1998 Apr;16(4):1554-60. doi: 10.1200/JCO.1998.16.4.1554.
To assess hematologic recovery and procedure-related mortality in patients who received high-dose therapy with stem-cell support, in whom the peripheral-blood stem-cell (PBSC) collection fails (CD34+ cells < 1 x 10(6)/kg). The predictive value of granulocyte-monocyte colony-forming cell (GM-CFC) measurements and the value of bone marrow obtained after PBSC collection failure was assessed.
The study group comprised 324 consecutive patients mobilized with granulocyte colony-stimulating factor (G-CSF) and cyclophosphamide (273 patients), G-CSF with other chemotherapy (37 patients), and G-CSF alone (14 patients). Between one and four aphereses were performed.
In 51 of 324 patients, there was failure to obtain 1 x 10(6)/kg CD34+ cells. Twenty-three patients had greater than 1 x 10(5)/kg GM-CFC; 22 patients proceeded to high-dose therapy. Neutrophil recovery occurred within 21 days, but platelet independence was delayed (> 28 days) in eight patients. Of 28 patients with less than 1 x 10(5)/kg GM-CFC, six received high-dose therapy with PBSC alone and five had delayed engraftment. Twelve patients with less than 1 x 10(5)/kg GM-CFC received high-dose therapy supported by bone marrow collected after PBSC collection failure. Eleven patients were assessable for engraftment; four patients had slow (> 21 days) or delayed (> 28 days) neutrophil recovery and eight patients had delayed platelet recovery. In the group of patients who received less than 1 x 10(5)/kg GM-CFC, there were five procedure-related deaths.
This study shows that delayed hematologic recovery is frequent if less than 1 x 10(6)/kg CD34+ cells are infused after high-dose therapy, particularly with GM-CFC less than 1 x 10(5)/kg. The procedure-related mortality in this latter group is high. In most patients whose PBSC collection contains less than 1 x 10(5)/kg GM-CFC, the use of bone marrow cells does not improve engraftment, which suggests that poor PBSC mobilization usually indicates poor marrow function.
评估接受高剂量干细胞支持治疗且外周血干细胞（PBSC）采集失败（CD34+细胞＜1×10⁶/kg）患者的血液学恢复情况及与治疗相关的死亡率。评估粒细胞 - 单核细胞集落形成细胞（GM - CFC）测量的预测价值以及PBSC采集失败后获得的骨髓的价值。
研究组包括324例连续患者，其中使用粒细胞集落刺激因子（G - CSF）和环磷酰胺动员的患者273例，使用G - CSF联合其他化疗药物的患者37例，仅使用G - CSF的患者14例。进行了1至4次单采。
324例患者中有51例未能采集到1×10⁶/kg的CD34+细胞。23例患者的GM - CFC大于1×10⁵/kg；22例患者继续接受高剂量治疗。中性粒细胞在21天内恢复，但8例患者血小板自主恢复延迟（＞28天）。在28例GM - CFC小于1×10⁵/kg的患者中，6例仅接受了PBSC高剂量治疗，5例植入延迟。12例GM - CFC小于1×10⁵/kg的患者在PBSC采集失败后接受了骨髓支持的高剂量治疗。11例患者可评估植入情况；4例患者中性粒细胞恢复缓慢（＞21天）或延迟（＞28天），8例患者血小板恢复延迟。在GM - CFC小于1×10⁵/kg的患者组中，有5例与治疗相关的死亡。
本研究表明，如果高剂量治疗后输注的CD34+细胞少于1×10⁶/kg，尤其是GM - CFC少于1×10⁵/kg，血液学恢复延迟很常见。后一组与治疗相关的死亡率很高。在大多数PBSC采集中GM - CFC少于1×10⁵/kg的患者中，使用骨髓细胞并不能改善植入情况，这表明PBSC动员不佳通常表明骨髓功能不良。
