两种血细胞分离机干/祖细胞采集和移植效果的比较

背景：外周血造血干/祖细胞通过血细胞分离机进行体外收集,血细胞分离机的性能、工作状况将直接关系到采集物的特性和数量,从而直接影响受者的造血重建。目的：比较Fenwal CS-3000Plus与Amicus两种血细胞分离机采集外周血造血干/祖细胞及受者移植效果。方法：共入选接受异基因外周血干细胞移植患者51例,Fenwal CS-3000Plus组27例,平均年龄（34.2±10.6）岁;Amicus组24例,平均年龄（35.4±12.1）岁。比较两组采集物有核细胞数、CD34＋细胞数、采集效率、红细胞与血小板采集量及造血重建时间。结果与结论：两组采集物的有核细胞数、CD34＋细胞数、采集效率、红细胞采集量及造血重建时间差异均无显著性意义;Fenwal CS-3000Plus组血小板采集量明显高于Amicus组（P〈0.01）。结果显示Fenwal CS-3000Plus与Amicus血细胞分离机在分离外周血干/祖细胞方面和移植效果没有差异;血小板较低被采集者使用Amicus血细胞分离机采集可能更为安全。     

Cobe Spectra与Fenwal CS 3000 Plus血细胞分离器外周血造血干/祖细胞的采集效能比较

为了评价Cobe Spectra(Version6.1)和Fenwal CS 3000 Plus两种血细胞分离机在造血干／祖细胞采集中的采集效能，对36人64次外周血造血干／祖细胞的采集进行了回顾性分析．20人42次使用Cobe Spectra采集，16人22次使用Fenwal CS 3000 Plus采集对CD34^ 细胞采集量、采集效率以及红细胞与血小板的采集量进行比较，结果表明：Cobe Spectra和Fenwal CS 3000 Plus在CD34^ 细胞采集量和采集效率上无显著差异?CD34^ 细胞采集量与供者白细胞、单核细胞、造血祖细胞、CD34^ 细胞的动员情况呈正相关，在多因素stepwise线性回归模型中，采集前外周血干／祖细胞浓度是唯一有意义的影响因素，Fenwal CS 3000 Plus的采集效率与外周血单核细胞量呈负相关。Fenwal CS 3000 Plus对红细胞的收集量显著高于Cobe Spectra，并且采集后供者外周血血小板降低程度较Cobe Spectra更严重。结论：Cobe Spectra(Version 6．1)和Fenwal CS 3000 Plus在CD34^ 细胞的采集能力上无显著差别。当外周血单核细胞数量高，或是血型不合移植的及血小板减少的供者，推荐使用Cobe Spectra血细胞分离机.     

两种血细胞分离机干/祖细胞采集效果及供者采集前后血液指标变化的比较

目的比较Fenwal CS-3000 Plus(以下简名称Fenwal)与Amicus 2种血细胞分离机分离外周血造血干/祖细胞的效果及干/祖细胞采集后供者血液指标的变化。方法共有56名供者入组,Fenwal组32名,年龄(36.2±11.6)岁,选择单个核细胞采集程序,共循环37次;Amicus组24名,年龄(35.4±12.1)岁,选择MNC采集程序共循环27次。比较2组采集物白细胞总数、单个核细胞百分率、CD34+细胞数及采集前后供者Hct、Plt的变化。结果2组采集物的白细胞数、单个核细胞百分率、CD34+细胞数、采集效率均差异无统计学意义;2组采集后供者Plt下降率Fenwal组供者较Amicus组高;2组采集后供者Hct下降率差异无统计学意义;2组采集物中MNC、CD34+细胞数均与外周血中MNC呈正相关,CD34+细胞百分率与外周血MNC无相关性。结论在分离外周血干/祖细胞方面Fenwal与Amicus没有明显差异。     

Amicus与CS-3000血细胞分离机采集外周血造血干细胞效果比较

目的 探讨Amicus与CS-3000血细胞分离机采集外周血造血干细胞的效果.方法 供者均给予G-CSF动员,分别采用Amicus血细胞分离机的MNC程序和CS-3000血细胞分离机的单个核细胞程序采集供者外周血干细胞;用流式细胞仪检测所采集干细胞的CD34+细胞数.供者52例,共采集62次,其中Amicus血细胞分离...     

ABO血型不合供者外周血造血干细胞的采集及移植效果研究

目的探讨应用CS-3000 Plus血细胞分离机采集ABO血型不合供者外周血造血干细胞的效率及不去除红细胞和/或血浆进行异基因外周血造血干细胞移植(PBSCT)的安全性。方法经G-CSF 5μg/(kg.d)动员的异基因外周血干细胞供者33名,应用CS-3000 Plus血细胞分离机的干细胞采集程序于动员后d 5采集,其中ABO血型主要不合12名,次要不合8名以及ABO血型相合13名。根据供者外周血的红细胞压积(Hct)和单个核细胞(MNC)计数,对分离机参数作相应调整。输注前从产品袋中留取干细胞,检测有核细胞数、MNC比例、CD34+细胞数、红细胞、血浆含量。单次处理循环血量(9 986±2 489)ml,抗凝剂用量(971±162)ml。供者采集前注射10%葡萄糖酸钙,以预防低钙反应。观察PBSC输注后受者的生命体征、尿液颜色及是否有溶血相关不良反应等。结果ABO血型主要不合组、次要不合组与ABO血型相合组采集物中的有核细胞数、CD34+细胞数、MNC比例无统计学差异(P>0.05),3组供者每次采集的PBSC产品终体积近60 ml,ABO主要不合组采集物中混入红细胞为(3.67—10.25)×1010/袋,ABO次要不合组采集物中血浆量为22—38 ml,不去除红细胞及血浆,直接回输给受者,均未出现溶血反应,所有患者造血功能均获得重建。结论应用CS-3000 Plus血细胞分离机采集ABO血型不合供者的外周血干细胞,通过调整分离机参数,减少ABO血型不合红细胞的混入,可以获得足够的干细胞数量并安全用于移植。     

2种血细胞分离机外周血干细胞采集效率的比较

目的 比较CS-3000 plus和COM.TEC血细胞分离机采集外周造血干细胞的效率.方法 56例检测标本均来自本院2011年自体外周血干细胞移植患者或异基因移植供者,其中CS-3000血细胞分离机采集33例,COM.TEC血细胞分离机采集23例.比较2组采集前供/患者的白细胞计数、红细胞压积;产品中白细胞数、单个核细胞比例、体外总循环量、产品体积、产品中MNC(单个核细胞总数)及单位循环量MNC、CD34+细胞总数及单位循环量CD34+.结果 CS-3000 plus与COM.TEC血细胞分离机采集产品中单个核细胞的比例有一定差异(P＜0.05),CS-3000 plus中单个核细胞比例高于COM.TEC血细胞分离机;CS-3000 plus产品体积显著小于COM.TEC 血细胞分离机产品体积(P＜0.05);按照单位循环量采集的细胞数,无论是以MNC还是CD34+细胞计算,2种机器采集效率的差异无统计学意义(P＞0.05),提示2种血细胞分离机均可采集足够的造血干细胞.结论 CS-3000plus和COM.TEC血细胞分离机在单个核细胞采集效率和CD34+细胞采集效率的差异无统计学意义.     

ABO血型不合供者外周血造血干细胞的采集

目的研究ABO血型不合供者外周血造血干细胞的采集方法,探讨不去除红细胞和/或血浆进行造血干细胞移植的安全性。方法 29例异基因外周血干细胞移植供者与受者HLA配型为全相合或1～3位点不合,其中ABO主要不合13例,次要不合7例,ABO血型相合9例。采用CS-3000Plus血细胞分离机的干细胞采集程序对ABO血型不合供者的外周血造血干细胞进行采集,不去除红细胞和/或血浆,直接回输给受者。结果 ABO血型主要不合、次要不合及血型相合的供者每次采集的外周血干细胞(PBSC)产品终体积为(59.11±1.19)ml,单个核细胞(MNC)采集物、MNC比例、CD34+细胞、RBC含量三组间的差异无统计学意义。结论应用CS-3000Plus血细胞分离机采集ABO血型不合供者外周血造血干细胞,不仅对供者安全,而且采集产品中造血干细胞浓度较高,血型不合的红细胞污染较少,不需要去除红细胞和血浆,可安全地用于ABO血型不合的受者。     

应用CS-3000 Plus血细胞分离机采集血型不合供者的外周血干细胞的临床研究

[目的]探讨应用CS-3000 Plus血细胞分离机采集ABO及Rh血型不合的供者外周血干细胞(PBSC)的得率及不去除红细胞或血浆用于异基因外周血干细胞移植的可行性.[方法]采用CS-3000 Plus血细胞分离机的自动干细胞采集程序对14例异基因外周血干细胞供者进行采集,其中ABO血型主要不合5例,次要不合6例,主要次要均不合2例,Rh血型主要不合1例.供者循环收集的细胞成分按供者外周血的红细胞比容(HCT)和单个核细胞(MNC)计数作相应调整.输注前从产品袋中留取标本检查有核细胞计数、MNC比例、CD34 细胞计数和台盼蓝拒染率.回输时对受者采取使用糖皮质激素、水化、碱化、利尿等保护措施.[结果]供者均经2～3次采集收集到足够的有核细胞直接回输给受者.共采集PBSC 30次,平均每次获得有核细胞5.65×1010,单个核细胞占96%～98%.CD34 细胞数平均为6.52×106/kg,细胞拒染率均为100%.ABO血型主要不合、主要、次要均不合及Rh主要血型不合的供者每次采集的PBSC产品终体积均为50 ml,产品中含压积红细胞3～7 ml,ABO血型次要不合供者每次采集的PBSC产品中含血浆15～25 ml,不去除红细胞及血浆,直接回输给受者,无一例出现溶血性输血反应,造血均获得重建.[结论]采用CS-3000Plus血细胞分离机,通过调整参数采集血型不合供者的外周血干细胞,减少血型不合的红细胞,可以获得足够的干细胞数量并安全用于移植.     

外周造血干/祖细胞采集的护理

目的 保证患者及健康捐献者外周造血干/祖细胞采集的顺利完成,确保达到造血干/祖细胞移植所需量.方法 用CS-3000Plus血细胞分离机对14例患者及14例健康捐献者进行外周血干/祖细胞采集,并在采集前、中、后实施观察及护理.结果 28例中静脉置管9例,静脉穿刺19例,经过1～2次采集,采集量达到造血干/祖细胞移植所需量.无1例出现呼吸循环功能不全.结论 采集时血管的选择及悉心护理保证了外周造血干/祖细胞采集的足量和质量.     

供者血细胞比容对机采血小板产品计数和收集效率的影响

为提高机采血小板制品的质量，保证临床输血的有效性，人们对血细胞分离机的自动化程度、操作程序以及制品质量等方面不断改进。Fenwal Amicus血细胞分离机是CS-3000plus的换代机型，笔者使用Amicus血细胞分离机采集供者血小板102例，以探讨供者血细胞比容对本机型采集产品的血小板计数、收集效率的影响。     

Peripheral blood stem cell apheresis for allogeneic transplants: Ibni Sina experience

BACKGROUND: The rate of utilizing peripheral blood stem cells (PBSC) as a source for allogeneic stem cells is growing rapidly. We aimed to demonstrate our 4 years experience as the largest apheresis center in Turkey and analyzed the content of the apheresis material. PATIENTS AND METHODS: From 1998 to the end of April 2002, 151 leukopheresis procedures were performed on 116 healthy donors (M/F:66/50) with a median age of 30 years (14-53). The HLA identical sibling donors received rhG-CSF 10 microg/kg/day sc. for 4 days and at the 5th day leukopheresis was started until collecting >4 x 10e6/kg CD34+ cells. Two times the donors' total blood volume was processed in 195 min (178-245) on continuous flow cell separators using peripheral venous access. RESULTS: Preapheresis WBC was 51.5 x 10e9/L (range, 13.11-91.3). Mono nuclear cell, CD34 and CD3 quantity of the harvest material were 5.35 x 10e8/kg (range, 0.45-23.46), 6.4 x 10e6/kg (range, 2.49-33.27) and 2.79 x 10e8/kg (range, 0.46-30.95), respectively. We were able to reach the target CD34 count after 1st cycle in 39% and 2nd cycle 61% of the procedures. In all donors with a peripheral blood CD34 count >80/mcl we succeeded to collect enough stem cells with only one leukopheresis. CONCLUSION: Collection of peripheral blood stem cells with continuous flow cell separators is well tolerated, with no mobilization failures or poor mobilizers. We collected high values of CD34+ cells (med. 6.4 x 10e6/kg) at the expense of high CD3+lymphocytes (med. 2.79 x 10e8/kg), which may increase the risk of acute and chronic GVHD after allogeneic hemapoietic cell transplantation.     

Kinetics of peripheral blood stem cell harvests during a single apheresis

BACKGROUND: The enumeration of CD34+ cells in the peripheral blood of patients before leukapheresis is commonly used to predict the outcome of stem cell harvests. The concept that an increased number of transplanted cells gives faster marrow reconstitution triggers an interest in investigating the kinetics of peripheral blood stem cells during leukapheresis. The aim of this study was to investigate the issue of recruitment of hematopoietic progenitor cells during a single leukapheresis. STUDY DESIGN AND METHODS: Nine leukapheresis procedures (in 8 patients) were investigated. In each case, 3 blood volumes were processed. Samples from peripheral blood, the collection line of apheresis equipment, and the collected component were obtained after each blood volume was processed. The enumeration of CD34+ cells was performed, and the total number of progenitors, as a sum of the number of cells in the peripheral blood and the number of cells in the collected component, was calculated. RESULTS: A mean of 13.3 L of blood was processed, and a component with a mean volume of 424 mL and a mean of 10.1 x 10(6) CD34+ cells per kg of body weight was collected. White cell and mononuclear cell counts in peripheral blood declined concomitantly during the procedures. The calculated total number of cells--that is, the sum of the number of cells in the collected component and the number of cells in the peripheral blood--showed a concomitant, but not equal, rise in polymorphonuclear cells, mononuclear cells, and CD34+ cells during the leukapheresis. This apparent mobilization of progenitors into the peripheral blood did not correlate with the slightly increased number of polymorphonuclear cells or with the more pronounced increase in mononuclear cells. CONCLUSION: There is a substantial recruitment of progenitor cells during a single leukapheresis.     

两种血细胞分离机分离外周血造血干细胞效果比较

目的　比较FenwalCS 3000plus及CobeSpectra两种血细胞分离机分离外周血造血干细胞的效果。方 法　共有76名供者入组。FenwalCS 3000plus组31例,平均年龄(39.1±12.9)岁,共循环38次;CobeSpectra组 45例,平均年龄(38.2±11.2)岁,共循环65次。比较两组采集物白细胞总数、单核细胞百分率、采集物单核细胞中 CD34+细胞百分率。结果　两组采集物的白细胞计数无明显统计学差异;FenwalCS 3000plus组单核细胞百分率 高于CobeSpectra组。两组采集物中CD34+细胞百分率无明显统计学差异。CobeSpectra组采集物中单核细胞百 分率与白细胞数负相关。两组单核细胞百分率、两组白细胞数均与CD34细胞百分率无相关性。结论　本组资料 显示在分离外周血干细胞方面FenwalCS 3000plus与CobeSpectra之间没有差异。     

Peripheral blood stem cell collection in a patient with chronic myelogenous leukemia and a high circulating nucleated red cell fraction

A high level of circulating nucleated red blood cells (NRBC) in patients with chronic myeloproliferative syndromes could potentially complicate peripheral blood stem cell (PSC) collection. The mononuclear NRBC might comprise a significant fraction of the total mononuclear cells in the final product. We report a successful PSC collection in a patient with more NRBC than WBC in the peripheral blood. A 27-year-old man with chronic myelogenous leukemia underwent eight PSC collection procedures, seven using the Cobe Spectra (Spectra) and one using the Fenwal CS3000 Plus (CS). PSC product manipulations to remove NRBC were unnecessary. As assessed by post-collection NRBC:WBC ratio as a percent of the initial ratio, Spectra selectively harvested mononuclear leukocytes over NRBC. The collected products had a mean NRBC:WBC ratio that was 3.4% of the peripheral blood ratio. Adequate numbers of mononuclear leukocytes were collected with less than 6% NRBC contamination. The single CS procedure resulted in a comparable NRBC reduction efficiency as the Spectra. We conclude that PSC harvest using automated blood cell separators from patients with a high level of circulating NRBC may result in a product with an acceptable number of NRBC.     

Comparison of two blood cell separators in collecting peripheral blood stem cell components

To ensure that a sufficient number of CD34+ cells are collected for an allogeneic blood progenitor cell transplant, the most effective blood cell separator should be used to collect peripheral blood stem cell (PBSC) components. We compared the effectiveness of two blood cell separators. We gave 29 healthy people 7.5 or 10 μg kg^?1 of granulocyte colony stimulating factor (G-CSF) daily for 5 days and collected one PBSC component with either a Fenwal CS3000 (n = 15) or a Cobe Spectra (n = 14) blood cell separator. The volume of blood processed was the same for each machine (8.4 ± 1.0 L; range = 4.9–9.4 L for the CS3000 and 8.9 ± 1.0 L; range 6.7–10.9 L; P = 0.71). The components collected with the CS3000 contained more mononuclear cells (39.6 ± 21.9 × 10⁹ compared with 26.9 ± 5.6 × 10⁹, P = 0.02) and fewer neutrophils (1.38 ± 1.88 × 10⁹ compared with 5.53 ± 8.71 × 10⁹, = 0.001). The total number of CD34+ cells collected with the two instruments was the same (470 ± 353 × 10⁶ for the CS3000 and 419 ± 351 × 10⁶ for the Spectra; P = 0.64) as was the number of CD34+ cells collected per litre of whole blood processed (55.9 ± 42.0 × 10⁶ L^?1 compared with 45.9 ± 37.9 × 10⁶ L^?1; P = 0.59). The mononuclear cell collection efficiency was greater for the CS3000 (82.4 ± 54.9% compared with 53.3 ± 14.1; P = 0.04) but the CD34+ cell collection efficiencies were the same (87.4 ± 61.1% for the CS3000 compared with 56.3 ± 23.5% for the Spectra; P = 0.07). In conclusion, both blood cell separators collected components which contained large numbers of CD34+ cells, but those collected with the CS3000 contained fewer neutrophils and the CS3000 was more efficient at collecting mononuclear cells.     

Apheresis techniques for collection of peripheral blood progenitor cells.

The combination of effective mobilisation protocols and efficient use of apheresis machines has caused peripheral blood progenitor cells (PBPC) transplantation to grow rapidly. The development of apheresis technology has improved over the years. Today PBSC procedures have changed towards systems to minimise operator interaction and to reduce the collection of undesired cells such as polymorphonuclear cells and platelets using functionally closed, sterile environments for PBSC collection in keeping with Good Manufacturing Practice guidelines. Blood cell separators with continuous flow technique allow the processing of more blood than intermittent flow devices resulting in higher PBSC yields. Large volume leukapheresis with the processing of 3-4-fold donor's/patient's blood volume can increase the number of collected progenitor cells. Therefore, intermittent flow cell separators are indicated if only single vein access is available. Anticoagulant induced hypocalcaemia is an often observed side effect in long lasting PBPC harvesting and monitoring of electrolytes should be performed especially at the end of the apheresis procedure to supplement low levels of potassium, calcium or magnesium. Refinement and improvement of collection techniques continue to add to the armamentarium of current approaches for cancer and non-malignant conditions and will enable future strategies.     

外周血造血干/祖细胞动员与采集时动态快速监测造血祖细胞的意义

为了获得高效的外周血干/祖细胞采集,探索一种简便、快速的外周血干/祖细胞监测方法，采用Sysmex XE-2100血细胞分析仪的幼稚细胞信号（IMI）检测通道识别和计数外周血造血祖细胞（HPC）。对25例行异基因外周血造血干细胞移植动员的供和11例自体外周血干细胞动员的患的外周血造血干/祖细胞进行了动态观察。于动员过程中取外周血进行HPC，CD34^ 细胞和CFU-GM的检测，对采集物也进行上述检测。结果表明：在外周血标本中HPC与CD34^ 细胞和CFU-GM二间均呈良好的正相关性。所有检测病例外周血CD34^ 细胞与HPC同时上升，同时达高峰。供的峰值出现在动员的第5天，快速升高晚于白细胞。而患外周血干/祖细胞的快速升高早于白细胞。采集物中HPC与CD34^ 细胞和CFU-GM呈正相关性。采集当日外周血中HPC和CD34^ 细胞计数与采集所得CD34^ 细胞数量亦具有良好的线性相关。结论：造血祖细胞的监测是一种快速、简便又经济的监测外周血干细胞采集时机和预测成功采集的可靠指标。     

Integration of biological, procedural, apheresis principles of peripheral blood stem cell transplantation programs

Collection and use of peripheral blood stem cells have rapidly replaced harvesting of pelvic bone marrow for transplant protocols. The mobilization of progenitor populations into the peripheral blood by chemotherapy and/or cytokine stimulation of marrow hematopoietic production has made it possible, in general, to collect larger quantities of progenitor populations than obtained in a single harvest of marrow. Technological advances through flow cytometry and generation of monoclonal antibodies to identify CD34 antigen expression on cells has provided a rapid means of assessing leukapheresis products for the presence of progenitor populations and has largely replaced the laborious 14 day culture assays' to measure colony forming units. Unlike apheresis platelet collection, where the yields are predictable through integration of donor biological variability, total volume of blood processed, and machine efficiency, CD34+ cell yields are not predictable. This has led to great diversity in stem cell collection procedures. Analyses of the same variables used to predict platelet yields, if applied to CD34+ cell collection, might lead to useful algorithms for development of standardized guidelines for stem cell collection.