Couban S, Dranitsaris G, Andreou P, Price S, Tinker L, Foley R, Walker I R, Jamal S, Jamal N, Spaner D, Lipton J, Meharchand J, Messner H A
Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Bone Marrow Transplant. 1998 Dec;22(12):1199-205. doi: 10.1038/sj.bmt.1701504.
Allogeneic peripheral blood progenitor cell (PBPC) transplants are an alternative to BMT, although G-CSF mobilization dose, timing of pheresis and risk of GVHD are not well defined. We compared harvest characteristics, donor and recipient outcomes and costs of two PBPC transplant strategies with historical controls who received BMT. Twenty donors mobilized with four daily s.c. G-CSF doses (5 microg/kg/day) (group 1) and 20 mobilized with 10 microg/kg/day G-CSF (group 2) were compared with 20 BM controls (group 3). G-CSF and phereses were well tolerated. Four of 40 PBPC donors required femoral catheter placement. At least 2.5 x 10(6) CD34+/kg recipient weight were collected with two phereses in 19/20 donors (group 1) and 18/20 donors (group 2). Time to neutrophil (18 vs 20 vs 22 days, P = 0.02) and platelet (21 vs 24 vs 27 days, P = 0.005) engraftment was shorter in the PBPC groups (group 2 vs group 1 vs group 3) but secondary engraftment outcomes were not different. The incidence of grade 2-4 aGVHD was higher in the low-dose G-CSF group (group 1) but there was no difference in cGVHD, 100-day or 1-year survival. The mean PBPC transplant cost (group 1) at first hospital discharge was less than BM (group 3) ($34,643 vs $37,354) but the mean overall cost for both groups was similar at 100 days ($46,334 vs $46,083). Allogeneic PBPC transplant with short course, low-dose G-CSF mobilization is safe, feasible and cost equivalent to allogeneic BMT.
异基因外周血祖细胞（PBPC）移植是骨髓移植（BMT）的一种替代方法，尽管粒细胞集落刺激因子（G-CSF）的动员剂量、单采时机和移植物抗宿主病（GVHD）风险尚未明确界定。我们将两种PBPC移植策略的采集特征、供者和受者的结局以及成本与接受BMT的历史对照进行了比较。20名供者通过每日皮下注射4次G-CSF剂量（5微克/千克/天）进行动员（第1组），20名供者通过10微克/千克/天的G-CSF进行动员（第2组），并与20名骨髓对照（第3组）进行比较。G-CSF和单采耐受性良好。40名PBPC供者中有4名需要放置股静脉导管。19/20名供者（第1组）和18/20名供者（第2组）通过两次单采收集到至少2.5×10⁶个CD34⁺/千克受者体重的细胞。PBPC组（第2组与第1组与第3组）中性粒细胞植入时间（18天对20天对22天，P = 0.02）和血小板植入时间（21天对24天对27天，P = 0.005）较短，但二次植入结局无差异。低剂量G-CSF组（第1组）2-4级急性移植物抗宿主病（aGVHD）的发生率较高，但慢性移植物抗宿主病（cGVHD）、100天或1年生存率无差异。首次出院时PBPC移植的平均成本（第1组）低于骨髓移植（第3组）（34,643美元对37,354美元），但两组在100天时的平均总成本相似（46,334美元对46,083美元）。采用短疗程、低剂量G-CSF动员的异基因PBPC移植是安全、可行的，且成本与异基因BMT相当。
