无关供者24例外周血干细胞动员和采集

目的 总结无关供者外周血千细胞(PBSC)动员和采集情况.方法 24例无关供者给予重组人粒细胞集落刺激因子(rhG-CSF)5 μμg·kg-1·d-1,每天皮下注射,第4、5天或5、6天用CS-3000PLUS血细胞分离机采集外周血干细胞,计数采集物中单个核细胞(MNC)和CD34+细胞.结果 所有供者均安全顺利完成...     

护理干预对外周血造血干细胞采集不良反应及采集细胞质量的影响

目的：护理干预对外周血造血干细胞采集不良反应及采集细胞质量的影响效果。方法本文选取80例外周血造血干细胞采集患者,对其分别实施不同护理操作,对比不同组护理干预工作开展的采集不良反应发生率、采集细胞质量水平大小结果。结果护理干预组患者出现的焦虑恐惧不安、失眠多梦以及食欲减退三项不良反应症状发生率分别是10．00％（4／40）、12．50％（5／40）以及7．50％（3／40）,和对照组患者的不良反应症状发生率结果对比存在显著性差异（ P＜0．05）。结论外周血造血干细胞采集之前,采用护理干预指导相关工作开展,可以有效降低采集过程中的不良反应发生率,提升采集质量,从而为干细胞顺利移植提供保证。     

自体外周血干细胞的动员采集及回输的护理27例

外周血干细胞移植(PBSCT)因造血恢复快．重建免疫功能强，并具有安全、简单、有效、肿瘤细胞污染少、适应症广、采集方便、所需费用低等优点．己在放、化疗敏感肿瘤治疗中广泛应用Ⅲ。移植成功的关键是要采集到足够数量的造血干细胞．以保证造血功能顺利恢复。我院2002年1月～2003年6月对27例自体外周血干细胞移植患的干细胞进行动员采集及回输，现将护理体会报告如下。     

大容量采集外周血干细胞

采用新型细胞分离机ＣＯＢＥＳｐｅｃｔｒａ采集健康供者和恶性淋巴瘤患者外周血干细胞 (ＰＢＳＣ)。资料和方法1　 4名健康供者 (异基因外周血干细胞移植供者 )分别是 4例急性白血病患者 (例 1～例 4)的同胞 ,经ＨＬＡ配型符合供者要求。供者 1的动员方案为 :ｒｈＧ ＣＳＦ 30 0 μｇ/ｄ× 5ｄ ,供者2 ,3,4的动员方案采用ｒｈＧ ＣＳＦ 30 0 μｇ/ｄ加ｒｈＧＭ ＣＳＦ 15 0 μｇ/ｄ ,连续 5ｄ。根据ＣＤ3 4 细胞含量均在第 6天采集ＰＢＳＣ。2　例 5～例 8进行自体ＰＢＳＣ移植　例 5、例 8为霍奇金病(ＨＤ)患者 ,动员采用环磷酰胺 (ＣＴ…     

儿童外周血造血干细胞采集

目的　探索儿童外周血干细胞 (PBSC)的采集 ,特别是体重 <2 0kg的小儿外周血干细胞采集方法。方法　 18例儿童 ,共 31次采集PBSC。①年龄小 ,血管细和不能很好地配合的儿童患者 ,在PBSC采集的前 1d ,根据患者的情况 ,选择性行锁骨下静脉、股静脉或颈内静脉穿刺 ,插入一儿童型双腔管 (18～ 36cm) ;②采集儿童PBSC时 ,使用SVSC分离槽和SVCC收集槽 ,体重 <2 0kg的小儿 ,在初始化完成后 ,使用经射线照射过的血液预先运转分离机 ,使儿童体内的血液保持平衡 ;③在分离过程中 ,ACD/全血的比例保持在 1∶11～ 1∶13之间 ;④成人的PBSC采集一般循环量为 10 0 0 0～ 15 0 0 0ml,儿童为全身血容量的 2～ 3倍 ,每次处理血液总量为 4 80 0～ 10 0 0 0ml。结果　除 2例采集 3次外 ,其余的经 1～ 2次PBSC采集 ,均收集到足够的MNC和CD3 4 细胞 ,达到外周血干细胞移植的阈值要求。结论　使用本方法能很好地采集儿童外周血造血干细胞。     

肿瘤患者自体外周血干细胞采集效果与影响因素的研究

目的探讨影响肿瘤患者行外周血干细胞采集效果的因素。方法采用MCS+血细胞分离机对79例采集前未动员的肿瘤患者(A组)行自体血外周血干细胞(PBSC)采集,所采集获得单个核细胞(MNC)和CD34~+细胞数分别与采集前白细胞(WBC)计数、血红蛋白(Hb)、体质量指数(BMI)、甘油三酯(TG)、载脂蛋白B(apoB)、红细胞比容(Hct)、血小板计数等因素进行相关性分析;同时与52例采集前动员的血液肿瘤患者(B组)所采集获得MNC和CD34~+细胞数进行比较。结果未动员的A组患者均采集成功:(1)其外周血中存在并能够采集到一定数量的MNC、CD34~+细胞。(2)与B组(动员组)比较,A组MNC、CD34~+细胞总数明显低于B组,差异有统计学意义(P<0.01),但A组与B组的MNC和CD34的百分数比较差异无统计学意义(P>0.01)。(3)采集物的MNC、CD34~+细胞数量与采集前自身的WBC计数、Hb、BMI、apoB、Hct、血小板计数、MNC均无明显相关性,而采集的MNC细胞数与采集前自身的TG水平是呈负相关。结论未作动员的肿瘤患者其外周血都可以安全地采集到一定浓度的、并能够满足临床治疗需要的PBSC。肿瘤患者自身PBSC采集效果与采集前TG水平因素有关联。     

外周血干细胞采集及有关因素分析

外周血干细胞采集及有关因素分析１０００８３北京医科大学第三医院禹涛，王良绪，安秀云，尉达民外周血中含造血干细胞已被证实。近年来，国内外已开始用大剂量化疗、全身放疗加外周血造血干细胞移植（ＰＢＳＣＴ）治疗血液系统恶性肿瘤及实体瘤。干细胞数量的多少对于Ｐ...     

自体外周血造血干细胞采集中对患者的护理

自体外周血造血干细胞移植治疗白血病 ,由于造血重建功能恢复迅速 ,又可避免移植物抗宿主病的优点 ,近年来已被临床越来越多采用。本站先后为两例患者进行外周血造血干细胞采集 ,现就采集过程中对患者的护理体会报道如下。1　材料与方法1.1　材料 :MCS 3P全自动血细胞分离机 (美国血液技术公司生产 )、采集用封闭式血液分离管道耗材(美国血液技术公司生产 )、无菌生理盐水每瓶5 0 0ml。ACD A血液抗凝剂每袋 5 0 0ml(上海血液中心生产 )、静脉注射用消毒用品及器材。1.2　方法 :按常规方法检测血细胞分离剂的各参数并选择PBSC程序 ,安装…     

一种安全的小儿外周血干细胞采集方法

外周血干细胞移植(peripheral blood stem cell transplantation,PBSCT)是治疗许多恶性血液病和某些实体瘤的有效方法,与骨髓移植相比具有许多优势,在临床上的应用日趋广泛,并有取代骨髓移植的趋势[1～3].对于成人外周血干细胞(PBSC)的采集,一般使用血细胞分离机可顺利完成.但对于小儿(特别是体重<20kg的小儿)的外周血干细胞采集则较为困难[4].一方面是安全性的原因(血容量和Hct的迅速变化),另一方面是采集有效性的原因.为此,笔者探索了一种小儿外周血干细胞采集的方法,经使用证明安全、有效,现报道如下.     

Optimizing pediatric peripheral blood stem cell collection

IntroductionPediatric PBSC harvests pose specific challenges during apheresis and a knowledge of the same and variables affecting PBSC collection are very important in planning these procedures. In the present study safety profile of pediatric PBSC procedures and variables influencing the successful collection were analyzed.MethodPediatric PBSC harvest data for 3 years was reviewed for donor, procedural and product parameters and any specific challenges faced during the procedures. Successful PBSC collection was defined when CD34 dose obtained was ≥2 × 10⁶ cells/Kg of recipients’ body weight.Results85 PBSC collections performed on 46 children (age range 1.5–15 years) were included. Sixty-two procedures were on autologous donors and 23 on allogenic donors. The median CD34+ cell dose in the PBSC product per procedure was 2.12 × 10⁶ cells/Kg for autologous procedures and 4.6 × 10⁶ cells/Kg for allogenic procedures. Systemic adverse reaction was observed during only one procedure (0.01 %) and was managed conservatively. Successful dose was collected in 52 procedures (61.17 %) and was significantly associated with CD34+ count of more than 19.7/μL, monocyte count of more than 1.65 × 10⁶/μL, allogenic collection and female gender (p = 0.00001, p = 0.011, p = 0.00052, and p = 0.0001, respectively).ConclusionPBSC collection is safe in pediatric age groups and pre-procedure CD34 count of ≥20/μL on the day of collection may result in successful collection of stem cell dose. It is important to identify factors associated with failed collection for appropriate counselling and justifying pre-emptive use of stem cell mobilizing agents.     

Infectious complications in patients receiving mobilization chemotherapy for autologous peripheral blood stem cell collection

The purpose of this retrospective study was to evaluate infectious complications in patients receiving mobilization chemotherapy for stem cell collection prior to autologous peripheral blood stem cell transplantation. An additional goal was to evaluate risk factors associated with the development of infectious complications. At the Medical College of Georgia BMT center, 54 patients were administered mobilization chemotherapy for the purpose of collecting stem cells between June, 1997, and May, 2002. All patients received Filgrastim in addition to chemotherapy, and 50 of 54 patients received prophylactic acyclovir, fluconazole, and ciprofloxacin until neutrophil recovery. The median duration to neutrophil recovery was 11 days. Fourteen of 54 (26%) patients developed fever/infections during the mobilization phase. One patient developed both a catheter-related infection and Clostridium difficile colitis, increasing the total number of infectious episodes to 15. Twelve patients had a documented site of infection whereas 2 patients had neutropenic fever with no identifiable source. Eight of the 15 (55%) infections were Gram-positive catheter infections. All the patients were treated successfully with antibiotics. No systemic fungal infections were identified and none of the patients died from complications related to mobilization chemotherapy. Logistic regression was applied for univariate and multivariate analysis and showed that age, sex, diagnosis, neutrophil recovery, disease status, use of salvage chemotherapy, and mobilization regimen used did not affect the infection rate. In our series of 54 patients, 14 patients developed fever/infections during mobilization. Although there is a substantial risk of infectious complications among patients who receive mobilization chemotherapy, it is not clear that prophylactic antibiotics decrease infectious complications. Because the vast majority of infections are Gram-positive catheter infections, it appears reasonable to employ Gram-positive prophylaxis. Controlled studies should be conducted to define the optimum mobilization regimens as well as the optimum combination of prophylactic antibiotics.     

Allogeneic peripheral blood stem cell collection as of 2008.

The rapid growth of the use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) to mobilize and collect allogeneic peripheral blood stem cells (PBSCs) for transplantation has made it a new international standard. While the procedure remains safe, older donors, donors with significant comorbidities and pediatric donors are now often employed. This brings a new set of challenges in the donor evaluation, medical clearance, informed consent and collection process. Rare and unexpected severe adverse events related to rhG-CSF administration and PBSC apheresis have been described. Proper PBSC donor counseling, evaluation and care have become even more important.     

Electrolyte monitoring in patients undergoing peripheral blood stem cell collection

In recent years peripheral blood stem cell (PBSC) collection for allogeneic or autologous transplantation has experienced an increased use in the onco-hematological setting. The latest generation cell separators allow a satisfactory and safe PBSC collection. Nevertheless, as in all therapeutic apheresis procedures, patients may experience procedure-related side-effects, mainly vasovagal reactions or symptoms related to hypocalcemia and/or hypomagnesemia. We investigated electrolyte changes in 18 patients, with a median age of 46 years (range 7–62), undergoing PBSC collection from January to April 1998. A significant decrease in total calcium in the final sample (9.65 ± 0.7 mg/dL) with respect to the basal one (9.2 ± 0.6 mg/dL, P < 0.05) was observed; also ionized calcium decreased markedly from the first sample drawn at +30 minutes: 1.22 ± 0.14 vs. 1.03 ± 0.15 mmol/L (P < 0.05), and a highly significant difference emerged when basal value were compared to the final value: 1.22 ± 0.14 vs. 0.94 ± 0.13 mmol/L (P < 0.0001). Similar findings affected potassium concentration: 4.1 ± 0.4 vs. 3.3 ± 0.3 mEq/L (P < 0.0001). Three out of eighteen patients (16.7%) reached a final potassium level <3.0 mEq/L, and eight out of eighteen (44.5%) showed a potassium concentration decrease >20% with respect to the basal value. A mild metabolic alkalosis occurred during the procedure: pH increased from 7.35 ± 0.02 to 7.43 ± 0.028 (P < 0.001), and plasma bicarbonate concentration increased from 27.48 ± 2.21 to 32.44 ± 2.52 mmol/L (P < 0.01). Sodium and chloride did not differ in the final sample with respect to the basal sample. None of our patients experienced clinically relevant side effects related to severe electrolyte changes (i.e., >20% with respect to the basal value). Because our current therapeutic schedules include patients older than 50 years in the PBSC collection and transplantation program and since it is well known that subclinical myocardial disease may occur in up to 4% of middle-aged males, we suggest that patients aged 50 or older undergoing PBSC collection procedures be carefully monitored in order to identify significant electrolyte variation, especially if they present with low serum potassium levels. However, further investigation of larger patient series are needed to determine the clinical relevance of serum potassium changes during apheresis. J. Clin. Apheresis 14:14–17, 1999. © 1999 Wiley-Liss, Inc.     

Kinetics of peripheral blood stem cell collection in large-volume leukapheresis for pediatric patients undergoing chemotherapy and adult patients before chemotherapy

The present study investigated the kinetics involved in collection CD34+ cells and colony-forming units-granulocyte-macrophages (CFU-GMs) during large-volume leukapheresis (LVL) in pediatric patients with malignancies and attempted to correlate the number of cells with the processed blood volume. In addition, adult cases were also examined using the same continuous flow blood cell separator to investigate the difference between children and adults. We examined 5 pediatric patients who had undergone chemotherapy before apheresis and 3 adult patients who were scheduled to undergo chemotherapy following apheresis. Collection was performed using a continuous-flow blood cell separator. Patients received granulocyte-colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells (PBSCs), except in the case of acute myelocytic leukemia. The processed blood volume was set to approximately 300 ml in children and 500 ml/kg of body weight in adults and the leukapheresis component was collected when approximately 50 ml of blood was processed. Six sequential samples were taken from each component in pediatric patients and 10 sequential samples from adults to obtain CD34+ cells and CFU-GMs. Counts of mononuclear cells (MNCs) and CD34+ cells in peripheral blood were measured just before and after each apheresis. Hemoglobin, hematocrit, and platelet counts in peripheral blood were monitored during apheresis. A total of 11 collections were performed for pediatric patients. The mean total CD34+ cells and CFU-GMs in each fractionated yield did not show a remarkable increase with increasing volume of blood processed. In adults, the kinetics of CD34+ cells in each fractionated yield were determined on a continuous basis and CFU-GMs increased during the course of apheresis. In pediatric patients, circulating MNCs and CD34+ cells were stable during apheresis, whereas in adult patients these cells decreased in the peripheral blood after apheresis. In both pediatric and adult patients, the platelet count in the peripheral blood decreased after apheresis. In contrast to adults, in pediatric patients who had been undergone chemotherapy, the collection efficiency did not appear to increase with increased volume of blood processed. Moreover, there was a marked platelet reduction in peripheral blood following apheresis. We conclude that the kinetics of collecting PBSCs by continuous flow blood cell separator is different between pediatric cases and adults cases. The application of LVL may be prudent in some children with malignancies, including those with a low platelet count and low body weight.     

81例外周血造血干细胞采集的护理与体会

目的探讨外周血造血干细胞采集的护理。方法对外周血造血干细胞采集进行全程护理,包括采前的科普宣教、环境准备、饮食及睡眠护理;采集过程中的生理和心理支持、建立良好血管通道、预防并及时处理各种不良反应等;采集后的防护、饮食、和沟通等。结果 81例均获得满意的采集效果。结论正确的护理可以顺利、高质量地完成外周血造血干细胞的采集。     

Timing of effective natural killer cell collection in cancer patients after high dose chemotherapy, compared to peripheral blood stem cell collection.

Natural killer (NK) and lymphokine-activated killer (LAK) activities in patients with seminoma were determined, and the timing of effective NK cell collection was evaluated, compared to autologous peripheral blood stem cell (PBSC) collection. After chemotherapy, patients were injected with granulocyte-colony stimulating factor (G-CSF). CD56 cells decreased in parallel with white blood cells and then were restored. After discontinuing the G-CSF, the CD56 cells increased and reached peak 3-5 days after PBSC collection. The peak showed higher levels than those at premedication. Recovery-peripheral blood lymphocytes (PBL) which were obtained 4 days after PBSC collection showed higher NK and LAK activities than the PBL obtained before chemotherapy (Before-PBL). They exhibited a high expression of CD2, CD18, CD29, and CD49d. Furthermore, the LAK cells generated from the Recovery-PBL could acquire 9.6 folds of killer unit compared with the Before-PBL-LAK. These results suggest that, in order to obtain large numbers of NK cells, Recovery-PBL collection may be more advantageous than PBL collection in no relation with the chemotherapy.     

自体外周血干细胞采集术的护理干预

[目的]探讨自体外周血干细胞移植病人围采集术期的护理。[方法]术前细致的心理护理、充分的睡眠及其他完善的术前准备;术中密切观察病人的病情变化并及时采取相应的护理措施;术后给予病人营养及生活护理指导。[结果]围采集术期的护理为成功实施自体外周血干细胞移植手术奠定了基础。[结论]正确的围采集术期护理有利于提高自体外周血干细胞移植的疗效,改善病人的生活质量。     

COAEP联合粒细胞集落刺激因子动员及采集造血干细胞在自体外周血干细胞移植中的应用

目的：探讨COAEP化疗方案联合粒细胞集落刺激因子（G-CSF）治疗对血液病患者外周血干细胞（PBSC）动员的效果。方法：选择恶性血液病患者24例，其中非霍奇金淋巴瘤（NHL）15例，多发性骨髓瘤（MM）6例，霍奇金病（HD）3例？以COAEP方案动员[dl（第1天）：环磷酰胺（CTX）400mg／m^2，长春地辛（VDS）2mg/m^2；dl-5应用阿糖胞苷（Ara—C）60mg／m^2．依托泊甙（VP-16）60mg／m^2，泼尼松（Pred）30mg／m^2]。将患者随机分为试验组和对照组。试验组取患者化疗后白细胞抑制达最低点开始稳定回升（第二次回升）时为节点．予G-CSF（惠尔血）300μg／d；而对照组以动员方案结束后向细胞跌至低谷首次回升时即使用G—CSF300μg/d。2组患者开始使用G—CSF后每日查血常规，当白细胞计数〉10．0×10^9／L和单个核细胞（MNC）计数〉1．0×10^9/L时使用COBE血细胞分离机，以自动单个核细胞分离程序采集PBSC．结果：使用COAEP方案动员后，24例恶性血液病患者平均获得的CD34＋细胞数达每例17．25×10^6/kg。试验组患者平均使用G—CSF的时间为4．17d，采集PBSC次数为1～2次，采集液CD34＋细胞数为每例11．73×10^6/kg（何均值）：对照组患者平均使用G—CSF的时间为5．92d，采集PBSC次数为1～2次，采集液CD34＋细胞数为每例1．79×10^6/kg（几何均值），2组间差异有统计学意义（P〈0．0028），结论：COAEP联合化疗可作为血液病患者自体PBSC动员的方案，并能获得良好的干细胞产率：患者白细胞开始稳定回升时使用G—CSF，可显著提高PBSC产率：根据患者外同血白细胞计数及单个核细胞数决定PBSC采集时机有效可行，值得临床推广。