Allogeneic peripheral blood stem cell transplantation in the treatment

Objective To investigate the efficacy of allogeneic peripheral blood stem cell transplantation (PBSCT) in the treatment of severe aplastic anemia (SAA) and severe infection. Methods A patient with SAA and pseudomonas aeruginosa septicemia was treated with PBSCT from an HLA-identical sibling with cyclophosphamide (CY) and total body irradiation (TBI) for conditioning. The patient was infused with 20.3×108/kg mononuclear cells including 61.0×106/kg CD34+cells following the conditioning regimen. Results Twenty days after PBSCT, the absolute neutrophil count (ANC) of 1.0×109/L was achieved, with platelet count >50×109/L. The donor origin of engraftment was confirmed by polymerase chain reaction (PCR) analysis of short tandem repeats at the end of the first, sixth and twelfth month. The patient’s body temperature dropped to normal level when her ANC reached 0.5×109/L on day 10, and the bacterial culture of blood sample became negative subsequently. Symptoms and signs of acute or chronic graft versus host disease (GVHD) were not observed in 30 months after PBSCT. Conclusions Hematopoiesis was reconstituted shortly after PBSCT. The combination of CY and TBI and the infusion of sufficient peripheral blood stem cells may contribute to the successful engraftment. PBSCT may be considered as the first choice when hematopoietic stem cell transplantation is needed for SAA patients complicated with severe infection.     

Role of adhesion molecules in mobilization of hematopoietic cells

Objectie To study the changes of adhesion molecules‘ expressions during the recombinant human granulocyte-colony-stimulating factor(rhG-CSF)mobilization in peripheral bolld stem cell transplantation (PBSCT),and to confirm the influence of rhG-CSF on hematopoietic stem cells,which are proposed to guide mobilization in PBSCT.Methods Mice were injected subcutaneously with diluted rhG-CSF or normal saline for 7 days.The blood Sca-1^ stem cell count and bone marrow(BM)nucleated cell count were enumerated.The expressions of CD49d and CD44 and the adhesive ability of mononuclear cells to bone marrow matrix(fibronectin)were examined by flow cytomety and ^51Cr adhesive assay,respectively.Results The mobilizing effect of rhG-CSF on mice was the same as on humans.The number of Sca-1^ cells in peripheral blood reached the peak on the seventh day,the BM nucleated cell count was reduced,and the expressions of CD49d and the cells‘ adhesive adility in BM and PB declined.Conclusions rhG-CSF can reduce some cell adhesion molecules‘ expressions and the adhesive ability of hematopoietic stem cells to BM matrix,therefore mobilizing hematopoietic stem cells(HSC) from the BM to the peripheral blood.     

A PILOT TRIAL FOR SEVERE,REFRACTORY SYSTEMIC AUTOIMMUNE DISEASE WITH STEM CELL TRANSPLANTATION

Objective To evaluate the feasibility, efficacy, and safety of high dose immunosuppressive therapy （HDIT） and autolognus hemopoietic stem cell transplantation （HSCT） with CD^34＋ cell selection in patients with severe, refractory autoim mune diseases. Methods Twenty-six patients with persistent systemic lupus erythematosus （SLE）, rheumatoid arthritis （RA）, primary Sjogren＇s syndrome （pSS）, or systemic sclerosis （SSc） who had been treated unsuccessfully with conventional treatment were enrolled in the trial in Peking Union Medical College Hospital from September 1999 to June 2004. The patients received HDIT with 200 mg/kg cyclophosphamide followed by an infusion of autologous stem cells that were CD34 selected. Disease acti- vity, adverse effect, hemopoietic and immune reconstitution, and time to recurrence of disease were monitored. Overall treatment related mortality was 7.7% （2/26） with 1 patient died of cytomegalovirus infection and an other of severe pneumonia. Relapse occurred in 3 SLE patients （17.6%） in 37, 26, and 19 months posttransplantation respectively, and 1 RA patient in 15 months posttransplantation. SLE Disease Activity Index （SLEDAI） scores of SLE survivors decreased significantly （P 〈 0.01）. RA patients recorded a drop of Disease Activity Score 28 （DAS 28）. The pSS patient remained symptoms free up to now, more than 50 months aider the transplantation. Conclusion HSCT can be performed relative safely in patients with severe autoimmune disease. Short-term effect of HSCT is promising. However treatment related mortality and relapse were observed in a subset of patients.     

Correlation of Thl7 cells and CD4＋CD25＋ regulatory T cells with clinical parameters in patients with systemic sclerosis

Background Systemic sclerosis （SSc） is an autoimmune disease that has three major components： inflammation, fibrosis, and vasculopathy. T-helper 17 cell （Th17） and regulatory T cell （Treg） are considered to be critical for autoimmune disease pathogenesis. The role of Th17 and Treg in SSc is still unclear. The aim of this study was to detect the presence of Th17s and CD4＊CD25~ Tregs in peripheral blood samples from SSc patients and to investigate the possible roles of these two T cell subsets in SSc pathogenesis. Methods Th17s （CD4 and IL-17 positive） and CD4＊CD25~ Tregs （CD4, CD25 and Foxp3 positive） in the peripheral blood mononuclear cells of 53 SSc patients and 27 healthy controls were counted by flow cytometry. The differences between SSc and control patients were analyzed. Clinical parameters, including disease duration, duration of the second symptoms, Modified Rodnan Skin Score （MRSS）, anti-topoisomerase I antibody, anti-U1 ribonucleoprotein （RNP） antibody, systemic involvements, pulmonary function test （PFT） and high resolution computed tomography （HRCT） score were prospectively collected following EUSTAR （EULAR scleroderma trial and research group） protocols. The correlations between the experimental and clinical data were investigated. Results The ratio of Th17 in SSc patients was significantly elevated compared to healthy controls （8.74% vs. 4.41%, P 〈0.001）. The amount of Th17 was positively correlated with disease duration （R=-0.531, P=-0.013） and duration of the second symptoms （R=-0.505, P=0.023）. The ratio of CD4＊CD25＊ Treg in SSc patients also significantly differed from the healthy controls （3.04% vs. 2.24%, P=0.018）. Elevated Tregs were more frequently observed in patients with a high interstitial lung disease （ILD） score on computed tomography （24/36） compared with patients with normal ILD scores （4/12, ,P=-0.043）. Elevated Tregs were also more often observed in patients with low carbon monoxide diffusing capacity     

Effect of Yiqi Bushen Granule (益气补肾颗粒) on the Peripheral Natural Killer Cell and γ δ T-cell in the Patients with Minimal Residual Leukemia

Objective: To analyze the changes in peripheral natural killer T-cells (NKT) and gammadelta T-cells (γδT-cell) in patients with minimal residual leukemia (MRL) before and after being treated with Yiqi Bushen Granule (益气补肾颗粒, YBG) in order to determine their significance in prognosis of the disease. Methods: Before and after treatment, the changes in 36 patients (16 males and 20 females) receiving long-term (more than 3 months) YBG therapy were analyzed using multi-parameter flow cytometry, with 34 healthy persons (19 males and 15 females) acting as controls. Results: The absolute value and percentage of NKT cells and γδT-cells were all significantly raised after treatment, for NKT cells, 0.52%±0.39% to 0.83%±0.66% and 7.25±7.77 cell/μL to 12.86±11.99 cell/μL, for γδT-cells, 6.08%±3.03% to 7.24%±2.78% and 83.97±48.09 cell/μL to 110.53±54.12 cell/μL, respectively (P0.05 or P0.01). Conclusion: YBG could regulate the immune function and elevate the amount of NKT cells and γδT-cells, thus to kill or suppress the residual leukemic cell in the body, which might be one of the mechanisms of YBG in prolonging the disease-free survival in MRL patients.     

Negative association of donor age with CD34+ cell dose in mixture allografts of G-CSF-primed bone marrow and G-CSF-mobilized peripheral blood harvests

Background The effects of donor characteristics on CD34＋ cell dose remain controversial. Recently, we developed a novel haploidentical transplant protocol, in which mixture allografts of granulocyte colony-stimulating factor （G-CSF）- primed bone marrow （G-BM） and G-CSF-mobilized peripheral blood （G-PB） were used. The aim of this study was to investigate the effects of donor characteristics on CD34＋ cell dose in mixture allografts of G-BM and G-PB. Methods A total of 162 healthy adult donors, who underwent bone marrow harvest and peripheral blood collection between January 2009 and November 2010 in Peking University People＇s Hospital, were prospectively investigated. G-CSF was administered subcutaneously at a dose of 5 pg/kg once a day for 5-6 consecutive days. Bone marrow and peripheral blood stem cells were harvested on the fourth day and fifth day, respectively. A final total CD34＋ cell dose less than 2× 106 cells/kg recipient body weight was considered a poor mobilization. Results Of the 162 donors, 31 （19.1%） did not attain this threshold. The obtained median CD34＋ cell doses in bone marrow, peripheral blood, and mixture allografts were 0.83×106/kg, 2.40×106/kg, and 3.47×106/kg, respectively. Multiple regression analysis showed that donor age had a significant negative effect on CD34＋ cell dose in either G-BM, or G-PB, or mixture allografts of G-BM and G-PB. And a 1-year increase in age was associated with a 5.6% decrease in the odds of achieving mobilization cutoff. No significant correlation was found for donor gender, body mass index （BMI）, and weight. Conclusion Donor age is the only factor among the four parameters, including age, gender, weight, and BMI, that influence CD34＋ cell dose in mixture allografts of G-BM and G-PB, and younger donors should be chosen to obtain sufficient CD34＋ cells for transplantation.     

Fludarabine and cytarabine combined chemotherapy followed by transfusion of donor blood stem cells for treating relapse of acute leukaemia after allogeneic haematopoietic stem cell transplantation

Background Relapse remains an obstacle to successful allogeneic haematopoietic stem cell transplantation （allo-HSCT） for patients with acute leukaemia and no standard treatment is available. We assessed fludarabine and cytarabine with transfusion of donor haematopoietic stem cell in treating the relapse of acute leukaemia after allo-HSCT. Methods Seven patients, median age 34 years, with relapse of acute leukaemia after allo-HSCT received combination chemotherapy of fludarabine with cytarabine for 5 days. Five patients suffered from acute myeloid leukaemia （2 refractory） and 2 refractory acute lymphoblastic leukaemia. After the transplantation, the median relapse time was 110 days （range, 38-185 days）. Two days after chemotherapy, 5 patients received infusion of donor＇s peripheral blood stem cells, mobilized by granulocyte colony stimulating factor. No prophylactic agents of graft versus host diseases were administered, Results Six patients achieved haematopoietic reconstitution. DNA sequence analysis at day 30 after treatment identified all as full donor chimera type. The median observation time was 189 days. After the treatment, the median time for neutrophilic granulocyte value 〉0.5×10^9/L and for platelet value 〉20×10^9/L were 13 days （range, 10-18 days） and 15 days （range, 11-24 days）, respectively. Graft versus host disease occurred in 2 patients （acute） and 3 （chronic）. Five patients suffered from pulmonary fungal infection （2 died）, 3 haemorrhagic cystitis and 2 cytomegalovirus viraemia. The other patients died of leukaemia related deaths. Three patients with chronic graft versus host disease who had received donor peripheral blood stem cells reinfusion have survived for 375 days, 232 days and 195 days, respectively. Conclusions Fludarabine with cytarabine plus the donor haematopoietic stem cell should be considered as an effective therapeutic regimen for relapse of acute leukaemia after alIo-HSCT. The disease free state of patients may increase, though with high ri     

Risk factors for bronchiolitis obliterans syndrome in allogeneic hematopoietic stem cell transplantation

Background The occurrence of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. We examine the role of pre-HSCT chemotherapeutic exposure, pre-HSCT comorbidities, and transplant-related complications in the development of BOS after allo-HSCT.

Methods A nested case-control study was designed. Cases with BOS and controls matched for the year of allo-HSCT and length of the follow-up were identified from a cohort of 1646 patients who underwent allo-HSCT for treatment of hematologic malignancies between 2006 and 2011. Antithymocyte globulin was used in the partial matched related and unrelated matched donor HSCT, or patients with severe aplastic anemia.

Results Thirty-six patients suffered from BOS; the mean age at the time of presentation was (32.7±12.4) years, and the mean time to presentation was (474±350) days post-HSCT. A pre-HSCT cyclophosphamide dose of ≥3.2 g/m2 (OR=8.74, P=0.025), chronic graft-versus-host disease (moderate to severe) (OR=12.02, P=0.000), and conditioning regimens without antithymocyte globulin (OR=2.79, P=0.031) were independently associated with BOS.

Conclusions We found that higher pre-HSCT cyclophosphamide exposure, a conditioning regimen without antithymocyte globulin, and moderate to severe chronic graft-versus-host disease are significantly and independently associated with BOS. Based on these results, we can identify patients who are at a higher risk of developing BOS after allo-HSCT, select a more appropriate therapeutic strategy, and improve the outcome of HSCT recipients.

     

Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome

Objective To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. Methods Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. Results A significant decrease was observed in all SARS patients in their peripheral CD4+ and CD8+ T lymphocyte absolute counts ［256(104)×10(6)/L and 256 （117）×10(6)/L, respectively］, which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8+ T lymphocyte counts in comparison with normal controls. Conclusions Decrease of both CD4+ and CD8+ T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.     

HX—97方案对外周血造血干细胞动员,采集和移植后造血重建的 …

为提高外周血造血干细胞动员、采集、和移植后造血重建的效率,作者从１９９７年４月至１９９年６月;进行了２２例异基因或自体外周血造血干细胞移植,对外周血造血干细胞动员、采集和移植后造血重建方案（ＨＸ－９７方案）作了系统观察。ＨＸ－９７方案的主要内容是：①外周血造血干细胞动员,采用ｒｈＧ－ＣＳＦ３００μｇ／天,皮下注射,共６天,第６剂在干细胞采集有９０分钟用;②自体外周血造血干细胞动员采用大剂量化疗加造     

MMC方案预处理后异基因外周血造血干细胞移植治疗慢性粒细？…

为进一步探讨慢性粒细胞白血病的治疗，对３例ＣＭＬ患者采用ＨＬＡ相合同胞史妹异基因外周血干细胞移植治疗，预处理方案为马法兰（Ｍ）１７０ｍｇ／ｍ＾２＊１，甲环亚硝脲（Ｍ）４００ｍｇ／ｍ＾２＊１，环磷酰胺（Ｃ）６０ｍｇ／ｋｇ＊２。     

丹参酮联合rhG-CSF动员高龄健康供者外周血造血干细胞的效果分析

目的研究丹参酮联合重组人粒细胞集落刺激因子(rhG-CSF)方案对高龄健康供者外周血造血干细胞的动员效果。方法回顾性分析2008年11月至2010年12月采用丹参酮联合rhG-CSF和单用rhG-CSF动员方案,动员高龄健康供者外周血造血干细胞的效果。其中丹参酮联合rhG-CSF组34例,单用rhG-CSF组31例;年龄45～60岁,平均49.6岁。中位体质量61.2kg(49.5～79.0kg)。给予丹参酮注射液(40mL/d)联合rhG-CSF 10μg.kg-1.d-1,或单用rhG-CSF 10μg.kg-1.d-1行外周血干细胞动员。动员第5天采集外周血单个核细胞(MNC),检测MNC和CD34+细胞数。采集外周血干细胞于当日输注给患者(预处理结束后24h)。结果丹参酮联合rhG-CSF组中30例供者1次采集充足,4例采集2次,平均采集MNC数6.7(5.9～14.3)×108/kg,CD34+细胞3.9(2.7～8.3)×106/kg;单用rhG-CSF组中22例1次采集充足,9例采集2次及以上,平均采集MNC数5.3(4.6～11.9)×108/kg,CD34+细胞数3.1(2.1～6.7)×106/kg,两组比较差异均有统计学意义(P<0.05)。造血干细胞移植预处理后所有患者均达到明显骨髓抑制,丹参酮联合rhG-CSF组供者中性粒细胞恢复到0.5×109/L时间为12.4(10～17)d,血小板(PLT)恢复到20×109/L时间为14.2(13～18)d;单用rhG-CSF组供者中性粒细胞恢复到0.5×109/L时间为12.8(10～18)d,PLT恢复到20×109/L时间为14.8(13～19)d,两组比较差异均无统计学意义(P>0.01)。结论丹参酮联合rhG-CSF动员方案可显著提高异基因造血干细胞移植高龄健康供者外周血干细胞动员效果,保证移植后造血功能的重建。对于高龄供者是一种安全有效的动员造血干细胞的方法,临床效果满意,值得推广。     

基质金属蛋白酶9在粒细胞集落刺激因子诱导的造血干/祖细胞动员中的作用

目的探讨基质金属蛋白酶9(MMP-9)在粒细胞集落刺激因子(G-CSF)诱导的造血干/祖细胞(HSPC)动员中的作用。方法应用酶联免疫吸附试验(ELISA)、免疫组织化学、逆转录聚合酶链反应(RT-PCR)等方法测定了健康供者稳态及G-CSF动员第5天骨髓、外周血MMP-9蛋白及mRNA水平的变化,比较富含MMP-9的细胞系HT1080无血清培养上清孵育前后CD34+细胞表面CXCR4表达及对基质细胞衍生因子1(SDF-1)的迁移能力的变化,将rhMMP-9与rhSDF-1孵育后应用Western印迹检测MMP-9对SDF-1的降解作用,观察注射MMP-9化学抑制剂(MPI)ο-邻二氮杂菲对G-CSF动员BALB/c小鼠外周血成熟白细胞计数(WBC)和干/祖细胞的数量的影响。结果G-CSF动员第5天,骨髓上清MMP-9浓度增加了6.6倍(P<0.01),骨髓组织表达MMP-9的中性粒细胞明显增多。动员后骨髓单个核细胞MMP-9mRNA表达水平上调(P<0.05)。rhSDF-1与rhMMP-9短期孵育后可被后者降解。HT1080无血清培养上清液能够上调脐血和动员外周血富集的CD34+细胞的CXCR4表达水平(均P<0.05)及增强CD34+细胞向SDF-1浓度梯度迁移能力(均P<0.05),该效应可被MPI阻断(P<0.05)。与G-CSF共注射MPI后BALB/c小鼠外周血成熟WBC(12.3×106/L±1.2×106/L)和造血祖细胞集落形成单位(69U/2×105MNC±3U/2×105MNC)数量显著低于对照组(P<0.05)。结论MMP-9可能通过裂解SDF-1、上调CD34+细胞表面SDF-1特异性受体CXCR4的表达及增强CD34+细胞迁移能力在G-CSF介导的HSPC动员中发挥重要作用。     

异基因造血干细胞移植后血小板植入失败行供者外周血造血干细胞输注治疗

目的对异基因造血干细胞移植（allo—HSCT）后血小板植入失败行供者外周血造血干细胞输注（GPBSCI）治疗的安全性、有效性进行初步评估。方法采用回顾性分析方法,针对2003年4月—2006年6月于北京大学血液病研究所行allo—HSCT的15例患者行16例次GPBSCI治疗的临床资料进行分析。结果15例患者中位年龄为33岁（14～48岁）,男性9例,女性6例,均为急慢性白血病患者,接受人类白细胞抗原（HLA）配型相合或不相合骨髓或骨髓联合外周血干细胞移植,回输骨髓单个核细胞（MNC）计数平均为（4．21±1．91）×10^8／kg[（1．50～7．46）×10^8／kg],回输外周血干细胞MNC计数平均为（3．27±1．40）×10^8／kg[（1．13—5．90）×10^8／kg],CD34^＋计数平均为（2．13±1．69）×10^6／kg[（0．24～5．67）×10^6／kg]。所有患者获得粒细胞植入,8例因原发性血小板植入失败,余8例因继发性血小板植入失败而实施GPBSCI治疗。回输中位时间为移植后＋113d（43～384d）。回输MNC计数平均为（3．09±1．54）×10^8／ks[（1．35～5．99）×10^8／kg]。仅1例患者在回输后出现急性移植物抗宿主病（aGVHD）表现。3例显著有效,6例有效,1例进步,6例无效。有效率为56．3％。其中移植后100d内进行2次回输疗效更好。结论对于allo—HSCT患者血小板植入失败,采取供者外周血造血干细胞2次回输,相关不良反应小,对促进受者造血恢复能够发挥一定的疗效。     

rhEPO和rhG-CSF对小鼠CD90~+细胞的动员作用

目的:探讨重组人促红细胞生成素(rhEPO)和重组人粒细胞集落刺激因子(rhG-CSF)对小鼠外周血CD90+细胞的动员作用。方法:30只雄性昆明小鼠随机分为对照组、rhG-CSF组和rhEPO组。rhG-CSF 40μg.kg-1.d-1、rhEPO 250 IU.kg-1.d-1连续皮下注射5 d;对照组连续皮下注射生理盐水。每组均于最后一次注射后6 h收集外周血,计数有核细胞(ANC)和单个核细胞(MNC),流式细胞仪检测外周血ANC中CD90+、CD34+CD90+和CD90+CD34-细胞的比例。结果:应用rhG-CSF和rhEPO动员后,小鼠外周血中ANC和MNC的数量均较对照组增加(P<0.05),但rhG-CSF和rhEPO两组之间无差异(P>0.05)。流式细胞术检测显示rhEPO组外周血ANC中CD90+细胞比例为(56.49±9.06)%,较rhG-CSF组明显增加(P<0.05);而rhG-CSF组和对照组CD90+细胞占ANC的比例无明显差异(P>0.05)。rhEPO组的CD90+CD34-细胞比例增至(53.5±8.9)%,占CD90+细胞中绝大多数。结论:rhEPO和rhG-CSF均有较强的造血干细胞动员能力,但rhEPO对CD90+细胞的动员作用强于rhG-CSF,提示rhEPO对早期造血干细胞可能具有更强的动员作用。     

Autogeneic peripheral blood hemopoietic stem cell transplantation for chronic myeloid leukemia with imatinib mesylate-induced negative Philadelphia chromosome]

OBJECTIVE: To study the possibility of curing chronic myeloid leukemia with autogeneic hemopoietic stem cell transplantation in patients with negative Philadelphia (Ph) chromosome induced by imatinib mesylate (STI 571) treatment. METHODS: Two patients with chronic myeloid leukemia in chronic phase, who had 90% Ph chromosome-positive cells and bcr/abl fusion gene-positive cells as shown by interphase fluorescence in situ hybridization (I-FISH), failed to respond favorably to interferon-alpha therapy in the treatment courses of 7 and 8 months, respectively. Treatment with STI 571 at a daily dose of 300 to 400 mg for 5 months to 8 months was subsequently implemented, after which the Ph chromosome and bcr/abl fusion genes became normal in detection for 3 times. Peripheral blood haemopoietic stem cell mobilization was then initiated by intravenous injection of cytarabine (2.0 g/d) for 3 days, etoposide (0.2 g/d) for 3 d and cyclophosphamide (1.0 g/d) for one day. When the white blood cell was below 1.0x10(9)/L, the G-CSF (300 microg/d) was administered subcutaneously for 5 or 6 d, and the peripheral blood mononuclear cells were collected by CS3000 Plus blood cell separator. The percentage of bcr/abl fusion gene-positive cells among CD34(9) cells enriched by MiniMAC ranged from 11% to 14%. After 3 or 4 weeks, the patients received total body irradiation at 9 Gy given in 2 fractions, with intravenous injection of cyclophosphamide (60 mg/kg daily) and etoposide (300 mg/d) for 2 d. On the day of transplantation, the collected mononuclear cells were 4.17x10(8)/kg and 3.9x10(8)/kg, with CD34(+)/ cells reaching 4.89x10(6)/kg.b.w and 4.89x10(6)/kg. CsA was also used since day -1 to day +13 of the transplantation for prevention of graft-versus-host disease. G-CSF was administrated daily at the dose of 300 microg subcutaneously from day +3 to +12. RESULTS: After the transplantation, the absolute neutrophil count (ANC) took a mean of 11 d to exceed 0.5x10(9)/L in these two patients, and 19 and 21 d, respectively, were needed for the platelet count to exceed 20x10(9)/L. The two patients showed cytogenetic relapse at 120 and 300 d after the transplantation, respectively. CONCLUSION: Autogeneic peripheral blood stem cells transplantation after Ph chromosome is negative in patients with chronic myeloid leukemia, who receive STI 571 treatment, may also relapse, and more radical elimination of Ph chromosome-positive cells is needed.     

自体与异基因外周血干细胞移植早期造血重建的初步研究

OBJECTIVE: To investigate the ratio and amount of CD34+ cells and their subsets in mobilized peripheral blood (MPB) and leukapheresis products in patients receiving autologous peripheral blood stem cell transplantation (auto-PBSCT) and in allo-PBSCT donors, and clarify the role of CD34+ cells in post-transplantation hematopoietic reconstitution. METHOD: Sixteen patients receiving auto-PBSCT and 24 allo-PBSCT donors were studied for CD34+ and CD34+CD38- cell ratios in the 115 MPB and their leukapheresis product samples by way of flow cytometry, and the time of hematopoietic recovery was observed in the two groups. RESULTS: The CD34+ cell ratio in the MPB samples and leukapheresis products was significantly lower in the donors than in auto-PBSCT patients (P<0.05), but CD34+CD38- cell ratio showed no obvious difference between the two groups. The amount of mononuclear cells (MNCs) received by allo-PBSCT patients was much more than that received by auto-PBSCT patients (P<0.01). Similar average times for post-transplant neutrophils recovery to over 0.5x10(9)/L and platelets to over 2 x 10(10)/L (P>0.05) were observed between the groups, and in both of them, the recovery was related to the amount of MNCs, CD34+ and CD34+/CD38- cell infusion. CONCLUSION: Irrespective of auto-PBSCT or allo-PBSCT, the number of CD34+ and CD34+CD38-cells infused after the transplantation is the key factor to influence the course of hemopoietic reconstitution.     

两种重组人粒细胞集落刺激因子动员异基因造血干细胞移植供者的随机临床观察

目的 比较两种重组人粒细胞集落刺激因子(rHuG-CSF)惠尔血和特尔津,对造血干细胞移植供者的动员疗效.方法 异基因造血干细胞移植(allo-HSCT)患者52例,人类白细胞抗原(HLA)配型全相合的同胞供者52例,随机采用两种rHuG-CSF特尔津和惠尔血分别进行供者造血干细胞动员,对供者千细胞动员参数及患者移植后造血重建等进行比较研究.结果 惠尔血组和特尔津组外周血白细胞计数高峰时间均为第4天(38.9±3.0)×109/L和(37.8±2.9)×109/L(P>0.05).惠尔血和特尔津两种动员剂对供者外周血造血干细胞参数的影响,其结果分别为采集物MNC计数(4.8±0.7)×108/kg vs(5.1±0.4)×108/kg;CD34+(1.6±0.3)×106/kg vs(1.9±0.7)×106/kg;惠尔血和特尔津两种动员剂对供者骨髓血造血干细胞参数有诸多方面的影响,其结果分别为采集物MNC计数(3.8±0.5)/L vs(3.9±0.7)/L;CD34+(1.3±0.7)×106/kg vs (1.5±0.4)×106/kg(均P>0.05).特尔津和惠尔血两种动员剂对造血干细胞移植后造血重建的影响,其结果分别为移植后中性粒细胞植活时间(14.6±0.9)d vs(15.2±1.6)d;血小板的植活时间(18.1±0.8)d vs(17.0±1.9)d(P>0.05);两种动员剂对造血干细胞移植供者不良反应无显著差异.结论 惠尔血和特尔津两种动员剂分别对供者外周血及骨髓的造血干细胞动员动力学,以及对患者造血重建影响均无显著性差异.特尔津能可靠用于造血干细胞供者的动员及患者移植后造血重建.