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1.
本研究旨在评价供者纯化的CD34+细胞在治疗异基因造血干细胞移植(allo-HSCT)后继发性移植物功能不良(poor graft function,PGF)的疗效及安全性.2009年1月至2011年12月10例allo-HSCT后继发PGF的患者,均给予G-CSF动员后的供者纯化CD34+细胞治疗,观察输注后相关并发症及患者生存情况.细胞分选采用cliniMACS系统,计算并统计分析分选纯度和CD34+细胞回收率.结果表明:纯化后的CD34+细胞纯度为(89.31±1.73)%,回收率达到(93.27±8.14)%,在10例患者输注过程中未发生严重的不良反映,均获得造血恢复,没有加重感染和GVHD等合并症的发生.结论:利用CliniMACS系统进行供者外周血CD34+细胞分选,所得CD34+细胞纯度、回收率均满意.供者纯化的CD34+细胞是治疗异基因造血干细胞移植后植入功能不良的一种安全、有效手段.  相似文献   

2.
目的探讨联合化疗加细胞因子动员自体外周血CD34+细胞的采集及临床级磁性分选仪(CliniMACS)分选的最佳方法,评价分选后CD34+细胞在造血干细胞移植中的应用效果.方法2001-03/2002-01在南京市鼓楼医院血液科病房收治自身免疫性疾病患者9例.符合纳入标准患者9例,男3例,女6例.采用环磷酰胺[2~4 g/(m2·d)]+粒细胞集落刺激因子(G-CSF)[5~10 μg/(kg·d)]作为动员剂,CS-3000Plus血细胞分离机采集外周血单个核样细胞,CliniMACS作CD34+细胞分选,观察分选前后的细胞计数、纯度、细胞活力,流式细胞术进行细胞表型检测及粒巨细胞集落形成单位(CFU-GM)培养.计算CD34+细胞的采集得率和分选回收率.观察CD34+细胞移植后造血功能恢复的情况.结果经环磷酰胺加G-CSF动员后,采集时机多以一次采集能够获得足够数量的CD34+细胞(CliniMACS分选和冷冻保存的耗损计算在内)为原则,外周血白细胞总数>6×109 L-1或CD34+细胞>0.4%时开始采集,其中8例采集1次,1例采集2次.每例患者可获单个核样细胞(MNC)总数(0.924~5.360)×1010,MNC(2.6~19.5)×108/kg,CD34+细胞(2.4~37.2)×106/kg,经CliniMACS系统分选后,CD34+细胞回收率为51%~93%,平均回收率为87%,CFU-GM回收率为35%~62%.CD34+细胞纯度为94.3%~98.4%,平均96.71%.CD3+,CD19+,CD56+,CD14+细胞去除2~4个对数级.经冰冻保存后的CD34+细胞的回收率为78%~99%,CFU-GM回收率为82%~99%,实际回输CD34+细胞为(2.0~8.3)×106/kg,移植后均获造血重建.结论掌握最佳动员、采集及分选方法,CD34+细胞可获较高产率,移植后造血功能恢复较快.  相似文献   

3.
目的:探讨联合化疗加细胞因子动员自体外周血CD34^+细胞的采集及临床级磁性分选仪(CliniMACS)分选的最佳方法,评价分选后CD34^+细胞在造血干细胞移植中的应用效果。方法:2001-03/2002-01在南京市鼓楼医院血液科病房收治自身免疫性疾病患者9例。符合纳入标准患者9例,男3例,女6例。采用环磷酰胺[2~4g/(m^2&;#183;d)]+粒细胞集落刺激因子(G-CSF)[5~10μg/(kg&;#183;d)]作为动员剂,CS-3000Plus血细胞分离机采集外周血单个核样细胞,CliniMACS作CD34^+细胞分选,观察分选前后的细胞计数、纯度、细胞活力,流式细胞术进行细胞表型检测及粒巨细胞集落形成单位(CFU-GM)培养。计算CD34^+细胞的采集得率和分选回收率。观察CD34^+细胞移植后造血功能恢复的情况。结果:经环磷酰胺加G-CSF动员后,采集时机多以一次采集能够获得足够数量的CD34^+细胞(CliniMACS分选和冷冻保存的耗损计算在内)为原则,外周血白细胞总数&;gt;6&;#215;10^9+L^-1或CD34^+细胞&;gt;0.4%时开始采集,其中8例采集1次,1例采集2次。每例患者可获单个核样细胞(MNC)总数(0.924—5.360)&;#215;10^10,MNC(2.6~19.5)&;#215;10^8/k,CD34^+细胞(2.4~37.2)&;#215;10^6/kg,经CliniMACS系统分选后,CD34^+细胞回收率为51%~93%,平均回收率为87%,CUF-GM回收率为35%~62%。CD34^+细胞纯度为94.3%~98.4%,平均96.71%。CD3^+,CD19^+,CD56^+,CD14^+细胞去除2—4个对数级。经冰冻保存后的CD34^+细胞的回收率为78%~99%,CFU-GM回收率为82%~99%,实际回输CD34^+细胞为(2.0~8.3)&;#215;10^6/kg,移植后均获造血重建。结论:掌握最佳动员、采集及分选方法,CD34^+细胞可获较高产率,移植后造血功能恢复较快。  相似文献   

4.
【目的】探讨免疫磁珠分选CD34 细胞及脐血中CD34 细胞含量的意义。【方法】脐血中分离单核细胞后,采用EasySep正选人CD34 免疫磁珠分选CD34 细胞,流式细胞仪检测分选前后CD34细胞的纯度。【结果】分选前MNC中CD34 细胞纯度为(1.14±0.71)%,分选后CD34 细胞纯度达到(91.55±4.11)%。【结论】脐血作为CD34 造血干/祖细胞的来源以及免疫磁珠方法在获得高纯度CD34 细胞中有重要的意义。  相似文献   

5.
目的探讨自体外周血CD34+细胞移植治疗严重自身免疫性疾病的干细胞动员、细胞采集和分选、预处理和并发症处理等问题.方法 10例重度自身免疫性疾病患者接受自体外周血CD34+细胞移植治疗.采用环磷酰胺(CTX)+rhG-CSF方案动员外周血干细胞,并以CliniMACS细胞分选仪分选CD34+细胞,适时用CTX+抗胸腺细胞球蛋白(7例)或CTX+全身照射(3例)两种预处理方案后,进行CD34+细胞回输的方法治疗.结果经CTX+rhG-CSF方案动员并以CliniMACS细胞分选仪分选后,可获得(1.98±0.95)×108的CD34+细胞,其纯度为(91.4±10.6)%,回收率为(60.5±19.8)%.在回输(2.14±1.05)×106/kg的CD34+细胞后,ANC ≥0.5×109/L的时间为(8.6±2.5)d,血小板升至20×109/L的时间为(9.0±5.2)d.在造血恢复后,所有CD3+细胞、CD19+细胞和CD16+CD56+细胞均未恢复至移植前状态.在造血和免疫抑制时,巨细胞病毒感染的发生率较高.2例患者死于移植相关并发症.所有患者近期疗效满意,6例系统性红斑狼疮患者DAI评分由移植前的平均17分降为移植后的4分;类风湿关节炎患者DAS28评分由6.4分降至1.8分;干燥综合征患者的症状和体征均明显缓解.结论对常规治疗无效的严重自身免疫性疾病,自体外周血CD34+细胞移植是可选择的治疗方法之一.  相似文献   

6.
徐勇  霍梅 《临床检验杂志》2004,22(4):246-248
目的 建立人外周血CD34 细胞及其亚群的纯化分离方法。方法 用干细胞采集仪收集了 3例病人的外周血干细胞 ,应用免疫磁珠分离柱快速分离其中的CD34 细胞 ,随后采用分选型EPICSElite流式细胞仪进一步分选出CD34 /CD90 双阳性早期造血干细胞。结果 免疫磁珠分离纯化后CD34 干细胞的纯度可达 83%~ 95 % ,回收率 5 4 %~ 71% ,活细胞率 >95 %。流式细胞仪分选后的CD34 /CD90 细胞纯度可达 90 %以上 ,回收率在 4 0 %~ 5 0 % ,生存率 >95 %。起始标本中CD34 细胞含量越高 ,纯化所得到的干细胞纯度和回收率越高。两种纯化后的干细胞在形态学上有明显的不同。结论 联合应用免疫磁珠分离和流式细胞仪分选 ,可以较高的回收率快速纯化高纯度的CD34 细胞及其亚群  相似文献   

7.
目的 探讨自体外周血CD34+ 细胞移植治疗严重自身免疫性疾病的干细胞动员、细胞采集和分选、预处理和并发症处理等问题。方法  10例重度自身免疫性疾病患者接受自体外周血CD34+细胞移植治疗。采用环磷酰胺 (CTX) +rhG CSF方案动员外周血干细胞 ,并以CliniMACS细胞分选仪分选CD34+ 细胞 ,适时用CTX +抗胸腺细胞球蛋白 (7例 )或CTX +全身照射 (3例 )两种预处理方案后 ,进行CD34+ 细胞回输的方法治疗。结果 经CTX +rhG CSF方案动员并以CliniMACS细胞分选仪分选后 ,可获得 (1.98± 0 .95 )× 10 8的CD34+ 细胞 ,其纯度为 (91.4± 10 .6 ) % ,回收率为 (6 0 .5± 19.8) %。在回输(2 .14± 1.0 5 )× 10 6 kg的CD34+ 细胞后 ,ANC≥ 0 .5× 10 9 L的时间为 (8.6± 2 .5 )d ,血小板升至 2 0× 10 9 L的时间为 (9.0± 5 .2 )d。在造血恢复后 ,所有CD3+ 细胞、CD1 9+ 细胞和CD1 6+ CD56+ 细胞均未恢复至移植前状态。在造血和免疫抑制时 ,巨细胞病毒感染的发生率较高。 2例患者死于移植相关并发症。所有患者近期疗效满意 ,6例系统性红斑狼疮患者DAI评分由移植前的平均 17分降为移植后的 4分 ;类风湿关节炎患者DAS2 8评分由 6 .4分降至 1.8分 ;干燥综合征患者的症状和体征均明显缓解。结论 对常规治疗无效的严  相似文献   

8.
目的 探讨自体纯化CD34+细胞移植治疗自身免疫性疾病(AID)的疗效.方法 对14例自身免疫性疾病患者进行自体纯化CD34+细胞移植.采用环磷酰胺(CTX)+G-CSF动员外周血干细胞,通过CliniMACS细胞分选仪分选CD34+细胞并冻存.预处理方案:8例采用氟达拉滨(FDB)+抗胸腺细胞球蛋白(ATG)+CT...  相似文献   

9.
目的为了预防高危白血病移植后的复发率,促进NK细胞相关的移植物抗白血病效应(GVL)而不增加移植物抗宿主病(GVHD)的风险,我们对5例高危难治白血病移植后进行了CD56+细胞富集的预防性供者淋巴细胞输注。方法 5例病例均为复发难治白血病,单倍体清髓移植后2个月以上;采集供者外周血淋巴细胞2次,一次性采用CD56~+免疫磁珠分选柱分(Miltenyi)一步分选,分别观察输注相关毒性、白血病复发、总生存,NK细胞活性测定2例,所有供患者均行KIR配型。结果 5例分选后CD56~+细胞纯度4例均在90%以上,1例为71.3%,分选回收率在48%~59.5%之间,2例分选后产品进行NK细胞活动测定提示杀伤活性良好,5例病例均未出现输注反应,输注后3个月内无输注相关的GVHD出现,输注后有3例复发(其中1例为髓外复发),总生存4例,1例死亡,3例无病生存,1例带瘤生存。结论 Clini MACS通过CD56~+分选柱分选供者来源的CD56~+细胞,对供者淋巴细胞进行NK细胞富集,分选纯度较高,产品用于造血干细胞移植后输注是安全的,且具有一定的疗效,更进一步的疗效可能需要反复多次输注,需要更多的样本进行明确。  相似文献   

10.
目的探索采用纯化的自体外周血造血干细胞移植治疗难治性幼年型类风湿性关节炎的临床效果。方法对3例难治性幼年型类风湿性关节炎患者进行纯化的CD34+细胞移植,动员得到外周血单个核细胞分别为8.23×108/kg、11.94×108/kg和9.32×108/kg;经CliniMACS CD34+细胞分选仪分选后得到CD34+细胞数分别为7.32×106/kg、8.75×106/kg和5.37×106/kg。采用BEAM+ATG预处理方案。结果发热的2例患者体温均降至正常,大关节肿痛均完全消失,四肢活动自如,血沉、C反应蛋白、类风湿因子各项指标正常,随访中疾病仍呈稳定状态。结论采用纯化的自体外周血造血干细胞移植可使患者造血功能得到较快重建,近期临床症状改善,是有效和安全的。  相似文献   

11.
The CliniMACS CD34+ selection device was used for positive selection of apheresis products for autologous transplantation from 10 patients with malignant diseases and for allogeneic transplantation from 26 healthy donors. A total of 71 separations were performed. In 1 allogeneic donor, CD34+ progenitors were also isolated from bone marrow. Between 0.27 and 8.9 x 10(10) nucleated cells (median 4.9 x 10(10)) containing 0.09%-10.8% (median 0.67%) CD34+ progenitor cells were separated. After separation, a median number of 227 x 10(6) mononuclear cells (MNC) (51-524) were recovered, with a median viability of 99% (22%-100%) and a median purity of 97.0% (68.3%-99.7%) CD34+ cells. Depletion of T cells was extensive, with a median of 0.04% residual CD3+ cells (range <0.01%-0.92%). Residual CD19+ cells were between <0.01% and 17%, including CD34+CD19+ cells. Recovery of CD34+ cells was calculated according to the ISHAGE guidelines and ranged from 24% to 105% (median 71%). We conclude that with the CliniMACS device CD34+ cells with high purity and recovery can be isolated with concomitant effective T cell depletion in the allogeneic setting and with a high purging efficacy in the autologous setting.  相似文献   

12.
Several devices for selection of CD34+ peripheral blood stem cells (PBSC) have been used during the last years for reducing tumor cell contamination of the graft. The new CliniMACS system (magnetic-activated cell separation system by Miltenyi Biotech GmbH, Bergisch-Gladbach, Germany) was recently approved for clinical use in Europe. To evaluate its purging efficiency and engraftment data in the autologous transplant, PBSC from 28 adult patients with various malignant diseases (non-Hodgkin's lymphoma, n = 17; chronic lymphocytic leukemia, n = 5; multiple myeloma, n = 4; acute lymphocytic leukemia, n = 1; medulloblastoma, n = 1) were mobilized by chemotherapy and granulocyte colony-stimulating factor (G-CSF) (10 microg/kg per day). Thirty leukapheresis products from 28 patients with a median of 4.4 x 10(8) nucleated cells/kg body weight (bw)(range 0.6-10.8 x 10(8)/kg bw) and a median of 7.1 x 10(6) CD34+ cells/kg bw (range 2.8 to 18.8 x 10(6)/kg bw) were selected using the Cobe spectra cell separator (Cobe BCT Inc., Lakewood, CO). After the CliniMACS procedure, the median yield of CD34+ selected cells was 4.5 x 10(6)/kg (range 2.2-11.1 X 10(6)/kg bw) with a median recovery of 69.5% (range 46.9-87.3%) and a median purity of 97.7% (range 89.4-99.8%). The procedure did not alter viability of selected cells, which was tested by propidium iodide staining. So far, purified PBSC were used for autologous transplantation in 15 out of 28 patients after total body irradiation and/or high-dose chemotherapy. Median time to reach an absolute neutrophil count > 500/microl was 12 days (range 10-18 days), platelet recovery >50,000/microl occurred at day + 16 (range 11-22). With a median follow-up time of 12 months (range 3-19), 5 patients died of relapse. We confirmed the feasibility and safety of the CliniMACS CD34+ cell enrichment procedure in adult patients with autologous PBSC transplantation.  相似文献   

13.
BACKGROUND: Selection of CD34+ PBPCs has been applied as a method of reducing graft contamination from neoplastic cells. This procedure seems to delay lymphocyte recovery, while myeloid engraftment is no different from that with unselected PBPC transplants. STUDY DESIGN AND METHODS: Lymphocyte recovery was studied in two groups of patients who underwent autologous CD34+ PBPC transplant with two different technologies (Ceprate SC, Cellpro [n = 17]; CliniMACS, Miltenyi Biotech [n = 13]). The median number of CD34+ cells transfused was 3.88 x 10(6) per kg and 3.32 x 10(6) per kg, respectively. Residual CD3 cells x 10(6) per kg were 4.97 and 0.58, respectively (p = 0.041). Residual CD19 cells x 10(6) per kg were 1.33 and 0.73, respectively (NS). RESULTS: No differences were found between the two groups in total lymphocyte recovery to >0.5 x 10(9) per L, which achieved a stable count by Day 30. During the study period, the CD4+ cell count remained below 0.2 x 10(9) per L, and the B-cell subset showed a trend toward normalization. CD3/HLA-DR+ and CD16/56 increased markedly in both groups by Day 30. An increase in CMV (13%) and adenovirus (17.4%) infection was found in both groups. CONCLUSION: Both CD34+ cell selection technologies used here determined an excellent CD34+ cell purity and an optimal depletion of T cells. The high rate of viral complications is probably due to the inability of residual T cells left from the CD34+ cell selection to generate, immediately after transplant, an adequate number of virus-specific lymphocytes.  相似文献   

14.
目的明确选择性CD34+细胞自体外周血干细胞移植(APBSCT)治疗多发性骨髓瘤(MM)的临床效果.方法对21例接受CD34+细胞APBSCT治疗的MM患者(选择组)和另外21例接受非选择性APBSCT的MM患者(对照组)的造血恢复时间、有效率、生存率、移植相关不良反应、移植费用进行比较.两组病例在年龄、初诊时血清β2微球蛋白水平和移植时疾病状态均具有可比性,诱导治疗及预处理方案基本相同.结果与对照组相比,选择组患者回输的CD34+细胞数显著偏低[对照组和选择组分别为9.4(1.1~15.0)×106/kg和2.2(0.5~14.3)×106/kg](P<0.001),中性粒细胞恢复至≥0.5×109/L和血小板恢复至≥20×109/L儿的中位时间,在选择组分别为10d和9d,对照组分别为9.5d(P=0.357)和4.5d(P=0.005).两组的治疗有效率相似(选择组85.7%,对照组90.4%),3年无病生存率(选择组和对照组分别为32%和39%)和总生存率(选择组和对照组分别为85%和79%)两组相比差异无显著性,而且使用非选择性APBSCT可明显降低移植费用.结论选择性CD34+细胞APBSCT与非选择性APBSCT相比,并不能改善MM的临床治疗结果,而且移植费用更大.  相似文献   

15.
BACKGROUND: In immunomagnetic selection of CD34+ cells from HPC transplants, not all factors that affect yield and purity of CD34+ cells are known. METHODS: Forty-three consecutive procedures of immunomagnetic selection of CD34+ cells from peripheral blood HPCs and bone marrow harvests (autologous harvests, n = 27; allogeneic harvests; n=16) were performed by use of a cell selection system (Isolex 300i, Baxter Immunotherapy). The composition of the starting component and the subsets of CD34+ cells were analyzed for correlation with the yield and purity of the final component. RESULTS: The mean purity of the final components was 84.3 percent (range, 27-99%), and the mean yield was 51.4 percent (range, 9.4-80. 4%). Partial regression analysis showed that, among the factors correlating with purity and/or yield, the RBC volume in the starting fraction had the highest predictive impact on the purity and yield of CD34+ cells, even after the exclusion of procedures using bone marrow harvests as an HPC source (beta coefficient, -0.704; p = 0. 001). CONCLUSION: The use of the Isolex 300i system allows efficient recovery of CD34+ cells in routine selection procedures. The volume of RBCs in the starting component should be minimized to ensure a high yield and purity of the final component.  相似文献   

16.
应用磁珠双阳性分选法在体外扩增阵发性睡眠性血红蛋白尿症(PNH)患的CD34 CD59 细胞,为实现PNH患进行临床自体骨髓移植(ABMT)或自体外周血干细胞移植(APBSCT)奠定基础。流式细胞术分选虽然经常用于细胞纯化,但难于满足大规模临床细胞分选的需要。本研究利用免疫磁珠系统,应用隔夜孵育法去除第一次分选时CD34 细胞吸附的磁珠,经过两次磁珠双阳性分选,从PNH患骨髓中分离出足够数量的CD34 CD59 细胞,用于体外培养扩增。结果显示:磁珠双阳性法分选的CD34 CD59 细胞与磁珠—流式细胞术二步分选法比较,在细胞生存、增殖、扩增及形成造血集落形成单位(CFU)的能力上均无显性差异。结论:磁珠双阳性分选法可能推广应用于其它双阳性或多阳性细胞的分离纯化,尤其是造血干/祖细胞的分离纯化。  相似文献   

17.
BACKGROUND: The isolation of CD34+ cells from mobilized peripheral blood is being increasingly used in the setting of allogeneic or autologous hematopoietic cell transplantation. Investigation of variables that may influence the effectiveness of CD34+ cell selection is of interest. STUDY DESIGN AND METHODS: Fifty-one CD34+ cell selections from peripheral blood progenitor cells (PBPCs) (39 allogeneic and 12 autologous) were performed using a magnetic cell separator (Isolex 300i, Baxter), including version 2.0 software. The results obtained were analyzed for different processing variables. The feasibility of transplanting these isolated CD34+ cells was also analyzed. RESULTS: The isolated CD34+ cell fraction had a median purity of 88.9 percent (range, 47.8-98.3). The median recovery of CD34+ cells was 45.1 percent (13.8-76.2), and the median colony-forming unit- granulocyte-macrophage (CFU-GM) content was 17. 2 percent (0.8-58.6). Logarithms of T- and B-cell depletion had median values of 3.7 and 2.8, respectively. The version 2.0 software of the Isolex 300i gave a higher CD34+ cell recovery in the enriched cell fraction (median 57.8%) than did version 1.11 (39.4%) or 1.12 (44.4%) (p = 0.01). The use of recombinant human deoxyribonuclease I during cell processing yielded more CD34+ cells (53% vs. 41%, p = 0. 01) and higher purity (92.8% vs. 87%, p = 0.03). There was a correlation between the percentage of CD34+ cells labeled with the monoclonal antibody 8G12 clone and the percentage of CD34+ cells labeled with the monoclonal antibody used during the processing technique (9C5 clone) in the initial, enriched, and depleted CD34+ cell fractions (R(2) = 0.95; 0.92; 0.78, p< 0.005, respectively). Median times for recovering >0.5 x 10(9) per L of granulocytes and >20 x 10(9) per L of platelets were 13 and 16 days in the allograft patients and 13 and 14 days in the autograft patients. CONCLUSION: CD34+ cells can be highly and effectively isolated from allogeneic and autologous grafts by use of this automated technique, with a high grade of T- and B-cell depletion. These purified CD34+ cell components can engraft normally.  相似文献   

18.
This prospective study was carried out in healthy donors and patients. The performance of the CliniMACS was evaluated with the comparison of the numbers of total nucleated cell (TNC) within and over the capacity of the normal scale column. In addition, large vs. normal scale column and manual vs. automated washing systems were also compared. A total of 44 selections were done. Eighteen normal scale selections were done with initial TNC numbers over 6 x 10(10) and 14 selections were performed below this number. None of the cases had CD34+ cell numbers over the capacity. Flow cytometry was used to check each separation performance for purity and recovery of CD34+ cells along with T- and B-cell depletion level parameters. All healthy donors had significantly better mean purity and recovery of CD34+ cells, and T- and B-cell depletion status than that of patients with values 95 vs. 85%, P: 0.006; 77 vs. 58%, P: 0.004; 4.55 log vs. 4.06 log, P: 0.004; 3.19 log vs. 2.63 log, P: 0.01, respectively. However, the performance of the system was not dependent on using the normal or large-scale column; automated or manual washing systems; and initial TNC numbers above (>6 x 10(10), range: 7.05-21.84 x 10(10), mean: 12.32 x 10(10)) or within (<6 x 10(10), range: 0.86-5.89 x 10(10), mean: 4.15 x 10(10)) the column capacity. In conclusion, the performance of the CliniMACS is more efficient in healthy donors than in patients. However, the performance of the system did not change as long as the numbers of CD34+ cells (range: 0.34-5.87 x 10(8)) were not exceeding the column capacity despite that more than 6 x 10(10) TNCs were used.  相似文献   

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