背景:造血系统恶性肿瘤的造血重建除与疾病本身、预处理方案、移植后支持治疗手段等相关外,自体外周血造血干细胞的动员、采集和冻存是影响其移植后造血系统顺利重建的关键因素.目的:观察造血系统恶性肿瘤患者自体外周血造血干细胞经动员、采集和冻存后,重新回输至造血系统的重建情况,并分析影响外周血造血干细胞数量和质量的因素.设计:以造血系统恶性肿瘤为对象的病例分析.单位:解放军广州军区广州总医院血液科,南方医科大学珠江医院血液科.对象:选取2000-02/2004-12解放军广州军区广州总医院血液科收治的18例造血系统恶性肿瘤住院患者,年龄16～56岁,其中急性髓性白血病2例,急性淋巴细胞白血病1例,淋巴瘤白血病2例,慢性粒细胞白血病2例,多发性骨髓瘤4例,非霍奇金淋巴瘤7例.粒细胞集落刺激因子(Granocyte,中外制药产品,批号N3G31).方法:①全部病例均采用对肿瘤有效的联合化疗方案+粒细胞集落刺激因子进行动员.联合化疗方案:白血病患者第1～3天每隔12 h给予阿糖胞苷2 g/m2,第1～5天给予足叶乙甙200 mg/m2或氟达拉宾50 mg/m2.多发性骨髓瘤患者给予阿糖胞苷方案同上,第1～2天给予环磷酰胺1 g/m2.淋巴瘤患者第1～2天给予环磷酰胺2 g/m2.各类型患者化疗后白细胞降至1.0×109 L-1以下时开始进行粒细胞集落刺激因子动员,5μg/(kg·d)皮下注射至采集结束.②当白细胞恢复至(4.0～10.0)×109L-1时开始采集外周血造血干细胞,单个核细胞计数≥4.0×108/kg或CD34+细胞≥2.0x105/kg时结束采集,经程序降温仪处理置入-196℃液氮中保存,37～40℃水浴解冻.③患者病灶部位行局部照射预处理,200 cGy/次,5次/周,连续4周,总剂量40 Gy.结束后48 h回输外周血造血干细胞(55.3±28.7)Ml,回输日距采集日平均为(56.5±22.3)d.全部患者于干细胞移植后第1天起皮下注射粒细胞集落刺激因子300 μg/d,至中性粒细胞≥0.5×109L-1时停止.检测冻存前及解冻后自体外周血造血干细胞的锥虫蓝拒染率、单个核细胞计数、粒-单系祖细胞集落数及CD34+细胞百分率.主要观察指标:①自体外周血造血干细胞的采集情况.②冻存后自体外周血造血干细胞存活率及相关指标检测.③自体外周血造血干细胞移植后造血系统重建情况.结果:18例造血系统恶性肿瘤患者全部进入结果分析.①18例患者自体外周血造血干细胞平均采集时间为化疗后12.6 d,采集次数为1.9次,采集第1天白细胞总数为(8.93+1.27)×10g L-1,单个核细胞采集率为(138.33±28.61)%.②冻存后18例自体外周血造血干细胞标本锥虫蓝拒染率与冻存前基本相似[(96.26±1.33)%,(92.75±2.04)%,P＞0.05].解冻后单个核细胞、CD34+、粒-单系祖细胞回收率分别为(91.96±1.37)%.(85.94±0.64)%,(87.69±4.53)%.骨髓瘤患者的单个核细胞采集率、CD34+细胞百分率及粒-单系祖细胞集落数均明显低于白血病和淋巴瘤患者(t=2.524～3.268,P＜0.05).③移植后15 d,15例患者中性粒细胞恢复至≥0.5×109L-1;移植后20 d,血小板恢复至≥20x109L-1.化疗疗程＞10次的5例患者粒-单系祖细胞生长不良.为(18.67～26.82)×105/kg,其中3例出现自体外周血造血干细胞移植后造血重建延迟.结论:①重组粒细胞集落刺激因子与大剂量化疗联合的动员方案可缩短外周血造血干细胞采集时间,提高单个核细胞采集率.②移植前化疗次数增多可影响自体外周血造血干细胞的数量和质量,导致造血重建延迟.
揹景:造血繫統噁性腫瘤的造血重建除與疾病本身、預處理方案、移植後支持治療手段等相關外,自體外週血造血榦細胞的動員、採集和凍存是影響其移植後造血繫統順利重建的關鍵因素.目的:觀察造血繫統噁性腫瘤患者自體外週血造血榦細胞經動員、採集和凍存後,重新迴輸至造血繫統的重建情況,併分析影響外週血造血榦細胞數量和質量的因素.設計:以造血繫統噁性腫瘤為對象的病例分析.單位:解放軍廣州軍區廣州總醫院血液科,南方醫科大學珠江醫院血液科.對象:選取2000-02/2004-12解放軍廣州軍區廣州總醫院血液科收治的18例造血繫統噁性腫瘤住院患者,年齡16～56歲,其中急性髓性白血病2例,急性淋巴細胞白血病1例,淋巴瘤白血病2例,慢性粒細胞白血病2例,多髮性骨髓瘤4例,非霍奇金淋巴瘤7例.粒細胞集落刺激因子(Granocyte,中外製藥產品,批號N3G31).方法:①全部病例均採用對腫瘤有效的聯閤化療方案+粒細胞集落刺激因子進行動員.聯閤化療方案:白血病患者第1～3天每隔12 h給予阿糖胞苷2 g/m2,第1～5天給予足葉乙甙200 mg/m2或氟達拉賓50 mg/m2.多髮性骨髓瘤患者給予阿糖胞苷方案同上,第1～2天給予環燐酰胺1 g/m2.淋巴瘤患者第1～2天給予環燐酰胺2 g/m2.各類型患者化療後白細胞降至1.0×109 L-1以下時開始進行粒細胞集落刺激因子動員,5μg/(kg·d)皮下註射至採集結束.②噹白細胞恢複至(4.0～10.0)×109L-1時開始採集外週血造血榦細胞,單箇覈細胞計數≥4.0×108/kg或CD34+細胞≥2.0x105/kg時結束採集,經程序降溫儀處理置入-196℃液氮中保存,37～40℃水浴解凍.③患者病竈部位行跼部照射預處理,200 cGy/次,5次/週,連續4週,總劑量40 Gy.結束後48 h迴輸外週血造血榦細胞(55.3±28.7)Ml,迴輸日距採集日平均為(56.5±22.3)d.全部患者于榦細胞移植後第1天起皮下註射粒細胞集落刺激因子300 μg/d,至中性粒細胞≥0.5×109L-1時停止.檢測凍存前及解凍後自體外週血造血榦細胞的錐蟲藍拒染率、單箇覈細胞計數、粒-單繫祖細胞集落數及CD34+細胞百分率.主要觀察指標:①自體外週血造血榦細胞的採集情況.②凍存後自體外週血造血榦細胞存活率及相關指標檢測.③自體外週血造血榦細胞移植後造血繫統重建情況.結果:18例造血繫統噁性腫瘤患者全部進入結果分析.①18例患者自體外週血造血榦細胞平均採集時間為化療後12.6 d,採集次數為1.9次,採集第1天白細胞總數為(8.93+1.27)×10g L-1,單箇覈細胞採集率為(138.33±28.61)%.②凍存後18例自體外週血造血榦細胞標本錐蟲藍拒染率與凍存前基本相似[(96.26±1.33)%,(92.75±2.04)%,P＞0.05].解凍後單箇覈細胞、CD34+、粒-單繫祖細胞迴收率分彆為(91.96±1.37)%.(85.94±0.64)%,(87.69±4.53)%.骨髓瘤患者的單箇覈細胞採集率、CD34+細胞百分率及粒-單繫祖細胞集落數均明顯低于白血病和淋巴瘤患者(t=2.524～3.268,P＜0.05).③移植後15 d,15例患者中性粒細胞恢複至≥0.5×109L-1;移植後20 d,血小闆恢複至≥20x109L-1.化療療程＞10次的5例患者粒-單繫祖細胞生長不良.為(18.67～26.82)×105/kg,其中3例齣現自體外週血造血榦細胞移植後造血重建延遲.結論:①重組粒細胞集落刺激因子與大劑量化療聯閤的動員方案可縮短外週血造血榦細胞採集時間,提高單箇覈細胞採集率.②移植前化療次數增多可影響自體外週血造血榦細胞的數量和質量,導緻造血重建延遲.
배경:조혈계통악성종류적조혈중건제여질병본신、예처리방안、이식후지지치료수단등상관외,자체외주혈조혈간세포적동원、채집화동존시영향기이식후조혈계통순리중건적관건인소.목적:관찰조혈계통악성종류환자자체외주혈조혈간세포경동원、채집화동존후,중신회수지조혈계통적중건정황,병분석영향외주혈조혈간세포수량화질량적인소.설계:이조혈계통악성종류위대상적병례분석.단위:해방군엄주군구엄주총의원혈액과,남방의과대학주강의원혈액과.대상:선취2000-02/2004-12해방군엄주군구엄주총의원혈액과수치적18례조혈계통악성종류주원환자,년령16～56세,기중급성수성백혈병2례,급성림파세포백혈병1례,림파류백혈병2례,만성립세포백혈병2례,다발성골수류4례,비곽기금림파류7례.립세포집락자격인자(Granocyte,중외제약산품,비호N3G31).방법:①전부병례균채용대종류유효적연합화료방안+립세포집락자격인자진행동원.연합화료방안:백혈병환자제1～3천매격12 h급여아당포감2 g/m2,제1～5천급여족협을대200 mg/m2혹불체랍빈50 mg/m2.다발성골수류환자급여아당포감방안동상,제1～2천급여배린선알1 g/m2.림파류환자제1～2천급여배린선알2 g/m2.각류형환자화료후백세포강지1.0×109 L-1이하시개시진행립세포집락자격인자동원,5μg/(kg·d)피하주사지채집결속.②당백세포회복지(4.0～10.0)×109L-1시개시채집외주혈조혈간세포,단개핵세포계수≥4.0×108/kg혹CD34+세포≥2.0x105/kg시결속채집,경정서강온의처리치입-196℃액담중보존,37～40℃수욕해동.③환자병조부위행국부조사예처리,200 cGy/차,5차/주,련속4주,총제량40 Gy.결속후48 h회수외주혈조혈간세포(55.3±28.7)Ml,회수일거채집일평균위(56.5±22.3)d.전부환자우간세포이식후제1천기피하주사립세포집락자격인자300 μg/d,지중성립세포≥0.5×109L-1시정지.검측동존전급해동후자체외주혈조혈간세포적추충람거염솔、단개핵세포계수、립-단계조세포집락수급CD34+세포백분솔.주요관찰지표:①자체외주혈조혈간세포적채집정황.②동존후자체외주혈조혈간세포존활솔급상관지표검측.③자체외주혈조혈간세포이식후조혈계통중건정황.결과:18례조혈계통악성종류환자전부진입결과분석.①18례환자자체외주혈조혈간세포평균채집시간위화료후12.6 d,채집차수위1.9차,채집제1천백세포총수위(8.93+1.27)×10g L-1,단개핵세포채집솔위(138.33±28.61)%.②동존후18례자체외주혈조혈간세포표본추충람거염솔여동존전기본상사[(96.26±1.33)%,(92.75±2.04)%,P＞0.05].해동후단개핵세포、CD34+、립-단계조세포회수솔분별위(91.96±1.37)%.(85.94±0.64)%,(87.69±4.53)%.골수류환자적단개핵세포채집솔、CD34+세포백분솔급립-단계조세포집락수균명현저우백혈병화림파류환자(t=2.524～3.268,P＜0.05).③이식후15 d,15례환자중성립세포회복지≥0.5×109L-1;이식후20 d,혈소판회복지≥20x109L-1.화료료정＞10차적5례환자립-단계조세포생장불량.위(18.67～26.82)×105/kg,기중3례출현자체외주혈조혈간세포이식후조혈중건연지.결론:①중조립세포집락자격인자여대제양화료연합적동원방안가축단외주혈조혈간세포채집시간,제고단개핵세포채집솔.②이식전화료차수증다가영향자체외주혈조혈간세포적수량화질량,도치조혈중건연지.
BACKGROUND:Hematopoietic reconstruction of malignant tumor in hematopoietic system is related to disease itself,pretreatment program and therapeutic tool after transplantation;especially,mobilization.collection and cryopreservation of auto-peripheral blood stem cell play a key role in successful reconstruction of hematopoietic system after transplantation.OBJECTIVE:To investigate the reconstruction of hematopoietic system through mobilization, collection and cryopreservation of auto-peripheral blood stem cell in patients with malignant tumor and analyze the effective factors on quantity and quality of auto-peripheral blood stem cell.DESIGN:Case analysis based on malignant tumor in hematopoietic system.SETTING:Department of Blood,Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA;Department of Blood,Zhujiang Hospital,Nanfang Medical University.PARTICIPANTS:A total of 18 patients with malignant tumor in hematopoietic system were selected from Department of Blood,Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA.Their ages ranged from 1 6to 56 years.Among them,2 patients had acute myelogenous leukemia(AML),1 acute lymphoblastic Ieukemia(ALL),2 lymphoblastic Ieukemia (LL),2 chronic granulocytic leukemia(CGL),4 multiple myeloma(MM),and 7 non.Hodgkin lymphoma.Granulocyte colony-stimulating factor(G-CSF)was made by Chugai Pharmaceutical Company Limited (batch number:N3G31).METHODS:①All patients were mobilized with associated chemotherapy+G-CSF.Associate chemotherapy:Patients with leukemia were given 2 g/m2 arabinosyl cytosine every 12 hours from lhe first to the third days and 200 mg/m2 etoposide or 50 mg/m2 fludarabine from the first to the fifth days. In addition patients with MM were treated with arabinosyl cytosine as the same way mentioned above and with 1 g/m2 cyclophosphamide from the first to the second days. And patients with lymphoma were given 2 g/m2 cyclophosphamide from the first to the second days. When numbers of leucocyte of all patients decreased below 1.0×109L-1 after chemotherapy.G-CSF started mobilization and the collection was stopped with 5μg/(kg·d)subcutaneous injection.②When numbers of leucocyte increased to (4.0-10.0)×109 L-1,hemopoietic stem cells of peripheral blood were collected till the amount of mononuclear cells≥4.0×108/kq or numbers of CD34+ cells≥2.0×108/kg.And then,the samples were dealt with cooling device.maintained in liquid nitrogen at-196℃ and defrosted in water bath at 37-40℃.③Focal sites of patients were pretreated with local irradiation with 200 cGy/time and 5 times/week for 4 successive weeks.The total dosage was 40 Gy.At 48 hours later,(55.3±28.7)mL hemopoietic stem cells of peripheral blood were transfused back. And the duration from transfusion to collection was about(56.5±22.3)days.300 μg/d G-CSF was subcutaneously injected into all patients at 1 day after transplantation and the reaction was stopped at the phase of neutrophil≥0.5×109L-1. Finally. Refusing-staining rate of trypan blue of peripheral blood stem cell, amount of mononuclear cells, number of granulation-monophyly progenitor cell colony and percentage of CD34+ cells were detected before and after thaw.MAIN OUTCOME MEASURES:①Collection of auto-peripheral blood stem cell;②survival rate and related markers of auto-peripheral blood stem cell after cryopreservation;③hematopoietic reconstruction of auto-peripheral blood stem cell after transplantation.RESULTS:All 18 patients with malignant tumor in hematopoietic system were involved in the final analysis.The mean collection time of auto-peripheral blood stern cell was 12.6 days after chemotherapy.the collection times were 1.9.total number of leucocyte was(8.93±1.27)×1 0.L-1 on the first day,and collection rate of mononuclear cell was (138.33±28.61)%. ②Refusing-staining rate of trypan blue of auto-peripheral blood stem cell was similar before and after cryopreservation[(96.26±1.33)%, (92.75±2.04)%,P＞0.05].in addition,after cryopreservation,recovery rates of mononuclear cells,CD34+ cells and granulation-monophyly progenitor cell were(91.96±1.37)%, (85.94±0.64)%and (87.69±4.53)%,respectively.Collection rate of mononuclear cells,number of granulation-monophyly progenitor cell colony and percentage of CD34+ cells were lower in patients with myeloma than in those with leukemia and lymphoma (t=2.524-3.268.P＜0.05).③At 15 days after transplantation,15 patients had the neutrophil≥0.5× 109L-1;at 20 days after transplantation,blood platelet was≥20 × 100 L-1.granulation-monophyly progenitor cells[(18.67-26.82)× 105/kg] of 5 patients grew poorly if the course of chemotherapy was more than 10 times.Among them,3 patients had delayed hematopoietic reconstruction after transplantation of auto-peripheral blood stem cell.CONCLUSION:①High-dose chemotherapy combined with G-CSF can shorten collection time of peripheral blood stem cell and improve collection rate of mononuclear cells.②Increase of chemotherapy times before transplantation can affect quantity and quality of auto-peripheral blood stem cell and cause delayed hematopoietic reconstruction.
