Bellido M, Sureda A, Martino R, Madoz P, García J, Brunet S
Servei d'Hematología Clinica, Hospital de La Santa Creu i Sant Pau, Barcelona, Spain.
Haematologica. 1998 May;83(5):428-31.
The combination of high or intermediate-dose cyclophosphamide (CY) plus granulocyte colony-stimulating factor (G-CSF) is useful to mobilize hematopoietic progenitor cells to peripheral blood, but the patients require hospitalization. The aim of this study was to evaluate the efficiency of low-dose CY plus G-CSF (5 ug/kg/day s.c.) as an outpatient treatment in order to collect enough progenitor cells for hematopoietic rescue in autologous peripheral blood transplantation (APBSCT).
We analyzed twenty-eight consecutively treated patients with lymphoma or multiple myeloma. The number of CD34+ cells in blood samples was determined from day +7. Leukapheresis (LKP) began when the absolute number of CD34+ cells in peripheral blood was > 2500/mL and the apheresis product was assayed for mononuclear cells (MNC), granulocyte-macrophage colony-forming units (CFU-GM), total nucleated cells (tNC) and CD34+ cells.
Twenty-eight outpatients with advanced hematologic malignancies (13 non-Hodgkin lymphoma, NHL; 10 Hodgkin's disease, HD; and 5 multiple myeloma, MM), median age 44 years (range 23-65) received a single dose of CY (1.5 g/m2 i.v. day 0) followed by G-CSF (5 ug/kg/day s.c.) from day +1 to the end of LKP. Considering patients who had successful mobilization (64%), a median of 7.1 x 10(6)/kg CD34+ cells (range 3.5-11.9), 5.7 x 10(5)/kg CFU-GM (range 1.5-9.2), 4.4 x 10(8)/kg MNC (range 1.9-7.9) were collected. Treatment was well tolerated and none of these patients was hospitalized due to neutropenic fever. Only one patient received two packed red blood cells following chemotherapy. Autologous peripheral blood stem cell transplantation (APBSCT) has been performed in 18 patients (64%). The mean number of days to achieve > 0.5 x 10(9) PMN/L and > 20 x 10(9) PLT/L was 12 (10-17) and 12.6 (8-24), respectively.
Considering a pre-established threshold of 2.5 x 10(6)/kg CD34+ cells to proceed to APBSCT, the mobilization therapy was successful in 64% of the patients but was unsuccessful in 10 patients (5 NHL, 4 HD and 1 MM). Hematopoietic recovery was complete and stable in all patients. Low-dose CY plus G-CSF is efficient to collect enough PBSC for hematopoietic rescue after myeloablative therapy in patients with lymphoprolipherative disorders or multiple myeloma.
高剂量或中剂量环磷酰胺（CY）联合粒细胞集落刺激因子（G-CSF）可有效动员造血祖细胞至外周血，但患者需要住院治疗。本研究旨在评估低剂量CY联合G-CSF（5μg/kg/天，皮下注射）作为门诊治疗的有效性，以便为自体外周血移植（APBSCT）收集足够的祖细胞用于造血挽救。
我们分析了连续接受治疗的28例淋巴瘤或多发性骨髓瘤患者。从第7天开始测定血样中CD34+细胞的数量。当外周血中CD34+细胞绝对计数>2500/mL时开始白细胞单采（LKP），并对单采产物进行单核细胞（MNC）、粒-巨噬细胞集落形成单位（CFU-GM）、总核细胞（tNC）和CD34+细胞检测。
28例晚期血液系统恶性肿瘤门诊患者（13例非霍奇金淋巴瘤，NHL；10例霍奇金病，HD；5例多发性骨髓瘤，MM），中位年龄44岁（范围23 - 65岁），于第0天静脉注射单剂量CY（1.5g/m²），随后从第1天至白细胞单采结束皮下注射G-CSF（5μg/kg/天）。在成功动员的患者（64%）中，中位收集到7.1×10⁶/kg CD34+细胞（范围3.5 - 11.9）、5.7×10⁵/kg CFU-GM（范围1.5 - 9.2）、4.4×10⁸/kg MNC（范围1.9 - 7.9）。治疗耐受性良好，这些患者均未因中性粒细胞减少性发热住院。仅1例患者在化疗后输注了2单位浓缩红细胞。18例患者（64%）已进行自体外周血干细胞移植（APBSCT）。达到>0.5×10⁹/L中性粒细胞和>20×10⁹/L血小板的平均天数分别为12天（10 - 17天）和12.6天（8 - 24天）。
考虑到预先设定的进行APBSCT的CD34+细胞阈值为2.5×10⁶/kg，64%的患者动员治疗成功，但10例患者（5例NHL、4例HD和1例MM）动员失败。所有患者造血恢复均完全且稳定。低剂量CY联合G-CSF可有效收集足够的外周血干细胞用于淋巴细胞增殖性疾病或多发性骨髓瘤患者清髓治疗后的造血挽救。
