CAJ | 학술논문

目的探讨外周血干细胞动员前中剂量阿糖胞苷(ID-Ara-C)化疗对急性髓系白血病(AML)动员效果的影响.方法收集1999年8月至2012年11月接受自体造血干细胞动员的90例AML患者的临床资料.所有患者完全缓解后接受依托泊苷+阿糖胞苷(EA)联合rhG-CSF方案进行外周血干细胞动员.白细胞恢复至4.0×109/L或监测外周血CD34+细胞≥1％时进行外周血干细胞采集.回顾性分析动员前ID-Ara-C化疗对AML动员效果的影响.结果根据ID-Ara-C化疗次数将患者分为A(＜2次)、B(2次)、C(＞2次)三组.A、B、C三组中位CD34+细胞数分别为4.7×106/kg、2.7×106/kg、2.3×106/kg (P=0.003).在可评估动员效果的87例患者中,CD34+细胞数≥2.0×106/kg 61例(70.1％),CD34+细胞数＜2.0×106/kg 26例(29.9％).在动员效果较差的26例AML患者中,A组7/46例(15.2％),B组10/21例(47.6％),C组9/20例(45.0％)(x2=10.05,P=0.007).C组患者采集足够量的外周血干细胞所需要的采集次数、总循环血量、rhG-CSF应用时间及剂量最多(P＜ 0.05).单因素分析显示动员前ID-Ara-C化疗次数及Ara-C累积量是动员效果的影响因素,而性别、年龄、预后分层、常规化疗与动员效果无显著相关性.多因素分析提示ID-Ara-C化疗次数是影响动员效果的唯一独立因素(OR=0.623,95％ CI=0.418～ 0.926,P=0.019).结论 ID-Ara-C化疗次数是影响AML外周血造血干细胞动员的独立影响因素.拟行自体造血干细胞移植患者应酌情控制ID-Ara-C化疗的次数.
목적 탐토외주혈간세포동원전중제량아당포감(ID-Ara-C)화료대급성수계백혈병(AML)동원효과적영향.방법 수집1999년8월지2012년11월접수자체조혈간세포동원적90례AML환자적림상자료.소유환자완전완해후접수의탁박감+아당포감(EA)연합rhG-CSF방안진행외주혈간세포동원.백세포회복지4.0×109/L혹감측외주혈CD34+세포≥1％시진행외주혈간세포채집.회고성분석동원전ID-Ara-C화료대AML동원효과적영향.결과 근거ID-Ara-C화료차수장환자분위A(＜2차)、B(2차)、C(＞2차)삼조.A、B、C삼조중위CD34+세포수분별위4.7×106/kg、2.7×106/kg、2.3×106/kg (P=0.003).재가평고동원효과적87례환자중,CD34+세포수≥2.0×106/kg 61례(70.1％),CD34+세포수＜2.0×106/kg 26례(29.9％).재동원효과교차적26례AML환자중,A조7/46례(15.2％),B조10/21례(47.6％),C조9/20례(45.0％)(x2=10.05,P=0.007).C조환자채집족구량적외주혈간세포소수요적채집차수、총순배혈량、rhG-CSF응용시간급제량최다(P＜ 0.05).단인소분석현시동원전ID-Ara-C화료차수급Ara-C루적량시동원효과적영향인소,이성별、년령、예후분층、상규화료여동원효과무현저상관성.다인소분석제시ID-Ara-C화료차수시영향동원효과적유일독립인소(OR=0.623,95％ CI=0.418～ 0.926,P=0.019).결론 ID-Ara-C화료차수시영향AML외주혈조혈간세포동원적독립영향인소.의행자체조혈간세포이식환자응작정공제ID-Ara-C화료적차수.
Objective To explore the impact of courses of intermediate-dose cytarabine (ID-Ara-C) chemotherapy on the efficiency of hematopoietic stem cell mobilization in acute myeloid leukemia (AML) patients with autologous hematopoietic stem cell transplantation (auto-HSCT).Methods 90 patients with de novo AML undergoing auto-HSCT between August 1999 and November 2012 were enrolled.All patients received the mobilization regimen of cytarabine and etoposide chemotherapy in combination with recombinant human granulocyte-colony stimulating factor (rhG-CSF).Stem cell apheresis was scheduled when blood leukocyte count recovered greater than 4.0 × 109/L or the proportion of CD34+ cells greater than 1％ in peripheral blood.The impact of ID-Ara-C courses on the mobilization efficiency was analyzed retrospectively.Results According to the ID-Ara-C courses,patients were divided into group A (＜ 2 courses),B (2 courses),and C (＞ 2 courses).The median doses of CD34+ cells (× 106/kg) in three groups were 4.7,2.7,2.3,respectively (P=0.003).Of the available 87 patients who could be evaluated,61 (70.1％) cases had CD34+ cells greater than 2.0 × 106/kg,and 26 (29.9％) cases less than 2.0 × 106/kg.Of the 26 patients without satisfactory mobilization efficiency,7 (15.2％) were in group A,10(47.6％) in group B,and 9(45.0％) in group C (x2=10.05,P=0.007).In addition,patients with satisfactory mobilization efficiency (CD34+ cells ≥2.0× 106/kg) in groups C needed more times of collection,more volume of blood processed,and even high-dose and longer course of rhG-CSF (P＜0.05).In univariate analysis.The ID-Ara-C courses and the cumulative dose were significant correlate with mobilization efficiency.In multivariate analysis,the ID-Ara-C courses was an independent correlation factor for mobilization efficiency (odd ratio=0.623,95％ confidence interval=0.418-0.926,P=0.019).The sex,age,cytogenetic risk,the standard chemotherapy courses did not correlate with mobilization efficiency.Conclusions The number of ID-Ara-C courses was independent factor for the mobilization efficiency and should be taken seriously in AML patients with auto-HSCT.