Rabitsch W, Reiter E, Keil F, Malzer R, Leitner G, Fischer G, Dieckman K, Kalhs P, Lechner K, Greinix H T
Dep. of Medicine I, BMT, University of Vienna, Austria.
Bone Marrow Transplant. 1998 Dec;22 Suppl 4:S49-52.
Between 1995 and 1997 twenty two patients with different hematological diseases ( CML n=10, AML n=6, ALL n=l, NHL n=3, SAA n=1,solid tumor n=1 ) and a median age of 37 (range, 20 to 55) years received unmanipulated peripheral blood stem cell (PBSC) transplants from HLA-identical sibling donors at our institution. Myeloablative chemotherapy consisted of cyclophosphamide (CY) and total body irradiation in 11, and chemotherapy alone in 11 patients. For graft-versus host-disease (GVHD) prophylaxis all patients were given cyclosporine A and methotrexate according to the Seattle protocol. PBSC were mobilized by granulocyte colony-stimulating factor (G-CSF) given at 10 microg/kg body weight (b.w.)/day for four days. Harvest of PBSC was started on day 5 and continued on day 6 if necessary. A median of 1 leukapheresis (range, 1 to 2) was performed and a median of 5.7 x 10(6) CD34+cells/kg b.w. (1.34 to 21.5) were obtained. Ten patients received G-CSF (5 microg/kg b.w.) starting on day one after PBSCT until neutrophil recovery. Absolute neutrophil counts >0.5 x 10(9)/L and ANC >1.0 x 10(9)/L were reached after a median of 13 (range 8 to 18) and 15 (range 9 to 19) days after PBSCT. Unsupported platelet counts >20 x 10(9)/L and 50 x 10(9)/L were reached after 17 (range 8 to 32) and 22 (range 13 to 40) days after PBSCT, respectively. Incidence of acute GVHD grade I to IV was 52%, extensive chronic GVHD occurred in 25% of patients. After a median observation time of 11 (range, 3 to 34) months twelve patients (55%) are alive and well. In summary, infusion of allogeneic PBSC after myeloablative therapy allows rapid and sustained hematologic reconstitution. Incidence of acute GVHD is not increased, for assessment of chronic GVHD longer observation times and larger patient numbers are required.
1995年至1997年间，22例患有不同血液系统疾病（慢性粒细胞白血病n = 10，急性髓细胞白血病n = 6，急性淋巴细胞白血病n = 1，非霍奇金淋巴瘤n = 3，重型再生障碍性贫血n = 1，实体瘤n = 1）、中位年龄37岁（范围20至55岁）的患者在我们机构接受了来自 HLA 匹配同胞供者的未处理外周血干细胞（PBSC）移植。清髓性化疗方案中，11例患者采用环磷酰胺（CY）和全身照射，11例患者仅采用化疗。为预防移植物抗宿主病（GVHD），所有患者均按照西雅图方案给予环孢素A和甲氨蝶呤。PBSC通过按10μg/kg体重（b.w.）/天给予粒细胞集落刺激因子（G-CSF）动员4天。PBSC采集于第5天开始，必要时第6天继续。中位进行了1次白细胞分离术（范围1至2次），中位获得5.7×10⁶个CD34⁺细胞/kg体重（1.34至21.5）。10例患者在PBSCT后第1天开始接受G-CSF（5μg/kg b.w.）直至中性粒细胞恢复。PBSCT后中位13天（范围8至18天）和15天（范围9至19天）时分别达到绝对中性粒细胞计数>0.5×10⁹/L和ANC>1.0×10⁹/L。PBSCT后17天（范围8至32天）和22天（范围13至40天）时分别达到血小板计数>20×10⁹/L和>50×10⁹/L。急性GVHD I至IV级的发生率为52%，25%的患者发生广泛慢性GVHD。中位观察时间11个月（范围3至34个月）后，12例患者（55%）存活且状况良好。总之，清髓性治疗后输注异基因PBSC可实现快速且持续的血液学重建。急性GVHD的发生率未增加，对于慢性GVHD的评估需要更长的观察时间和更多的患者数量。
