G—CSF对化疗后外周血干细胞动员作用的影响

通过对１１例急性白血病患单独化疗与化疗后加用粒细胞集落刺激因子（Ｇ－ＣＳＦ）的对比，动态观察了Ｇ－ＣＳＦ对外周血造血干细胞（ＰＢＳＣ）的动员作用。发现化疗后加用Ｇ－ＣＳＦ比单用化疗的粒－巨噬细胞集落形成单位（ＣＦＵ－ＧＭ）增加５．１倍，红系式集落形成单位（ＢＦＵ－Ｅ）增加４．５倍。Ｇ－ＣＳＦ还可使ＣＦＵ＞１００／ｍｌ和ＢＦＵ－Ｅ＞２００／ｍｌ的持续时间延长；化疗后ＣＦＵ－ＧＭ的最高值提早出现，而     

血小板第4因子及四肽AcSDKP的造血保护作用研究

目的了解血小板第４因子（ＰＦ４）和四肽Ｎ乙酰丝天赖脯（ＡｃＳＤＫＰ）对５氟尿嘧啶（５ＦＵ）处理后小鼠体内造血的作用。方法实验鼠用ＰＦ４（４０μｇ／ｋｇ）或ＡｃＳＤＫＰ（４μｇ／ｋｇ）注射２次,间隔６小时,第２次注射后２０小时再注射５ＦＵ（１５０ｍｇ／ｋｇ）。第６,８和１３天时,检查高增殖潜能的集落形成细胞（ＨＰＰＣＦＣ）、红系爆式集落形成单位（ＢＦＵＥ）、粒巨噬系集落形成单位（ＣＦＵＧＭ）、巨核系集落形成单位（ＣＦＵＭＫ）及巨核细胞（ＭＫ）。结果ＰＦ４或ＡｃＳＤＫＰ可促使６～８天的ＨＰＰＣＦＣ以及８天的ＢＦＵＥ和ＣＦＵＧＭ明显增加;ＰＦ４还能促进８天的ＣＦＵＭＫ和ＭＫ增加,但ＡｃＳＤＫＰ则无此作用。结论ＰＦ４和ＡｃＳＤＫＰ虽然对巨核祖细胞的作用不同,但它们均能加速体内ＨＰＰＣＦＣ、ＣＦＵＧＭ和ＢＦＵＥ的恢复,这两种分子有可能具有保护造血细胞抵抗化疗药物杀伤的作用。     

外周血干细胞的动员和采集及移植后造血重建研究

对２４例外周血干细胞（ＰＢＳＣ）移植的三种动员方案、采集及移植后的ＰＢＳＣ数量与造血重建关系进行研究。２４例中急性白血病１３例，多发性骨髓瘤６例，非霍奇金淋巴瘤４例，晚期乳癌１例。三组动员方案：化疗＋四氢叶酸＋氟美松；化疗＋ｒｈＧＭ－ＣＳＦ＋氟美松；化疗＋ｒｈＧ－ＣＳＦ＋氟美松。用流式细胞仪双染色直接免疫荧光法测定ｒｈＧ－ＣＳＦ组中９例ＣＤ３４＋ＣＤ３３＋细胞。结果表明：ｒｈＧ－ＣＳＦ组ＰＢＳＣ产率最高，平均每例单个核细胞（９．８６±６．０１）×１０８／ｋｇ，ＣＦＵ－ＧＭ（２１．０８±１６．８６）×１０４／ｋｇ，ＣＤ３４＋细胞数与ＣＦＵ－ＧＭ正相关（ｒ＝０．６８）。动员后再用ｒｈＧ－ＣＳＦ１周，ＣＤ３４＋细胞显著增多，可连续每日采集，当≥５×１０６／ｋｇ即可停止；采集与回输的ＰＢＳＣ数与造血重建时间密切相关。     

脐血造血干／祖细胞集落产率的研究

对３１例脐血及３１例正常成人骨髓细胞进行体外培养，分别检测其ＣＦＵ－ＧＭ，ＢＦＵ－Ｅ，巨核细胞集落形成单位（ＣＦＵ－Ｍｅｇ），粒、红、巨噬细胞集落形成单位（ＣＦＵ－ＧＥＭ），粒、红、巨噬、巨核细胞集落形成单位（ＣＦＵ－ＧＥＭＭ）及初始造血祖细胞——粘附于基质的原始细胞集落形成单位（ｓＣＦＵ－Ｂｌ），对比分析其造血细胞的层次结构。发现脐血晚期祖细胞含量接近骨髓，早期祖细胞含量则高于骨髓。经推算２１天时ｓＣＦＵ－Ｂｌ含量可达骨髓的１０倍左右。提示脐血长期重建造血的能力优于骨髓，一份脐血重建成人造血理论上是可能的。     

脐血CD_(34)~ CD_(19)~－细胞与体外培养集落的相关性分析

用两种单克隆抗体（单抗）标记脐血造血祖细胞表面抗原（ＨＰＣＡ，ＣＤ＿（３４））用流式细胞仪分析，并比较两种单抗标记的细胞与体外培养的粒单细胞集落形成单位（ＣＦＵ－ＧＭ），红系爆式集落形成单位（ＢＦＵ－Ｅ）和混合集落形成单位的相关性，结果表明脐血有核细胞中，抗ＨＰＣＡ－２－ＦＩＴＣ阳性的细胞占１．０５１０．７２％，Ｔｕｋ３（纯抗体）阳性细胞占２．０６±１．２５％，差别显著（Ｐ＜０．０５），每μｌ脐血两种单抗标记的细胞分别为９６．５６±５６．６４和２３１．４０±１６３．９３（Ｐ＜０．０５），变异系数依次为５８．４７％和６８．４３％。尽管抗ＨＰＣＡ－２－ＦＩＴＣ阳性细胞与阳性细胞数量呈显著正相关，但前者与ＣＦＵ－ＧＭ，ＢＦＵ－Ｅ，ＣＦＵ－Ｍｉｘ以及ＣＦＵｓ（ＣＦＵ－ＧＭ＋ＢＦＵ－Ｅ＋ＣＦＵ－Ｍｉｘ）均呈正相关，而后者仅与ＣＦＵ－ＧＭ，ＣＦＵｓ呈正相关。研究结果提示在检测造血祖细胞时，用抗ＨＰＣＡ－２－ＦＩＴＣ代替可降低假阳性，获得较好的细胞与ＣＦＵ间的线性关系。     

自体外周血干细胞动员中测定CD34^＋Thy—1＋细胞的意义

目的：确切评估动员后外周血干细胞（ＰＢＳＣ）水平的变化，及时指导临床选择最佳采血时机。方法：用流式细胞术测定化疗和粒细胞集落刺激因子（Ｇ－ＣＳＦ）联合动员时外周血ＣＤ３４＋Ｔｈｙ－１＋细胞含量的变化，同时用体外集落培养方法评价外周血祖细胞（ＰＢＰＣｓ）的克隆形成能力。结果：动员后循环血中ＣＤ３４＋Ｔｈｙ－１＋细胞、ＣＤ３４＋细胞和克隆形成细胞（ＣＦＣ）含量分别增高４８．６倍、５０．０倍和５３．１倍，高峰时间在化疗后第１２～１４天（注射Ｇ－ＣＳＦ的第６～８天）；外周血单个核细胞中ＣＤ３４＋Ｔｈｙ－１＋细胞、ＣＤ３４＋细胞的比例分别增高１３．８倍和１０．５倍；动员的早期阶段，ＣＤ３４＋细胞中Ｔｈｙ－１＋细胞比例最高。结论：联合应用化疗和Ｇ－ＣＳＦ对ＰＢＰＣｓ，尤其对早期干／祖细胞具有显著动员作用；用流式细胞术检测ＣＤ３４＋Ｔｈｙ－１＋细胞可及时指导临床准时采集ＰＢＳＣ。     

人脐血造血干,祖细胞体外培养的实验研究

采用体外细胞培养的方法，检测了脐血、骨髓、外周血ＣＦＵ－ＧＭ，ＢＦＵ－Ｅ。结果表明脐血中ＣＦＵ－ＧＭ，ＢＦＵ－Ｅ数量高于成人外周血，同骨髓相比，ＣＦＵ－ＧＭ数量无显著差异，ＢＦＵ－Ｅ低于骨髓。同时观察到脐血中ＣＦＵ－ＧＭ大集落比例明显高于骨髓；ＣＦＵ－ＧＭ集落产率时间曲线较骨髓延迟３～４天；Ｓ期ＧＭ－ＣＦＣ所占比例明显低于骨髓，可能提示脐血造血细胞中早期造血细胞比例高于骨髓。实验中还发现脐血红系集落生长同骨髓十分相似，二者均含ＣＦＵ－Ｅ和ＢＦＵＥ集落，而外周血中只含ＢＦＵ－Ｅ集落。我们统计了２７份脐血血量及所含有核细胞数。根据骨髓移植的有核细胞数标准（２×１０￣８／ｋｇ），一份脐血的有核细胞数很难达到此要求，但已达到目前国外小儿异体脐血移植成功病例的有核细胞数值。     

基因重组干扰素γ体外对骨髓增生异常综合征患者造血祖细胞的作用

对基因重组干扰素γ（ＩＦＮ－γ）体外对３２例骨髓增生异常综合征（ＭＤＳ）患者造血祖细胞的作用进行了研究，结果如下：①ＭＤＳ患者ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ明显低于对照组，ＣＦＵ－Ｅ减低者占３０／３２例，ＣＦＵ－ＧＭ减低者占３１／３２例。②ＩＦＮ－γ体外可促进ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ数增加，其作用为剂量依赖型，在ＩＦＮ－γ浓度为１００Ｕ／ｍｌ时达最大值。③ＩＦＮ－γ对ＭＤＳ患者ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ的促增殖作用与患者自身集落数有关，在自身集落数正常和稍减低者这种作用最明显，在明显减低者这种作用小甚至为０．④上海和日本二种干扰素作用相似，无显著差异。以上结果提示ＩＦＮ－γ对ＭＤＳ治疗可望产生良好效果。     

人粒系巨噬系克隆刺激因子基因导入真核细胞及其表达

目的：获得带糖链、近天然的重组人粒系巨噬系克隆刺激因子（ｈＧＭ－ＣＳＦ），以期为临床提供更安全、稳定的细胞因子。方法：采用基因重组技术，构建编码ｈＧＭ－ＣＳＦ的稳转载体ｐＭＥｎｅｏ－ｈＧＭ－ＣＳＦ，以酶切和猴肾细胞ＣＯＳ瞬时转染鉴定后，用磷酸钙－ＤＮＡ共沉淀法将重组质粒导入中国仓鼠卵细胞（ＣＨＯ）。结果：经Ｇ４１８加压筛选（８００μｇ／ｍｌ～１ｍｇ／ｍｌ），获得可表达ｈＧＭ－ＣＳＦ的细胞株。常规或载体培养ＣＨＯ－ｈＧＭ－ＣＳＦ细胞株上清可直接刺激ｈＧＭ－ＣＳＦ依赖细胞株的增殖，ＭＴＴ测定活性单位可达１×１０７ｕ／Ｌ原液。ＳＤＳ－ＰＡＧＥ及Ｗｅｓｔｅｒｎｂｌｏｔ分析显示ｒｈＧＭ－ＣＳＦ主带在２８ＫＤ位左右，为２Ｎ糖链型。结论：此ＣＨＯ－ｈＧＭ－ＣＳＦ细胞株表达稳定，活性较高，具有开发价值。     

脐血造血祖细胞培养及细胞周期的研究

应用造血祖细胞体外培养和流式细胞术（ＦＣＭ），观察了脐血中粒－单系祖细胞（ＣＦＵ－ＧＭ）和红系爆式集落（ＢＦＵ－Ｅ）的数量和特性，并对其细胞增殖周期和成人骨髓及外周血做比较。结果显示，脐血中含丰富的ＣＦＵ－ＧＭ和ＢＦＵ－Ｅ，其数量低于骨髓而超过外周血水平；脐血ＢＦＵ－Ｅ对红细胞生成素和爆，式促进活素表现出更高的敏感性；脐血Ｓ期、Ｇ＿２＋Ｍ期及Ｓ＋Ｇ＿２Ｍ期细胞数均明显低于骨髓，虽略高于外周血各期细胞数，但差别无显著性意义。     

红细胞生成素和重组细胞因子对动员后外周血造血祖细胞、红系爆式祖细胞和粒巨噬系祖细胞的集落形成和自我更新的作用

本研究探讨红细胞生成素（EPO）和重组细胞因子（G－CSF，SCF，IL－3和GM－CSF）对患者和健康供者动员后的外周造血祖细胞的红系爆式祖细胞（BFU－E）和粒巨噬系祖细胞（CFU－GM）的集落形成和自我更新的作用。为了更好的了解上述那一种细胞因子和如何联合对干细胞的扩增更为有效，采用甲基纤维素半固体培养法，观察在单独用EPO、G－CSF的基础上，比较联合SCF，IL－3和GM－CSF对BFU－E和CFU－GM的作用。结果显示：①在EPO＋IL－3和EPO＋SCF＋IL－3组，外周血BFU－E自我更新显著增加，而EPO＋SCF组则明显增加。②患者与正常供者之间BFU－E的自我更新无显著差别。③G－CSF联合SCR，IL－3和GM－CSF后CFU－GM集落形成显著增加。患者组仅G－CSF本身可使CFU－GM集落形成显著增加，而G－CSF＋SCF和GMix组CFU－GM集落形成明显增加。④当G－CSF联合SCF，IL－3和GM－CSF可能显著增加CFU－GM的自我更新（AUC）。GMix是CFU－GM的集落形成和祖细胞扩增的较佳组合。⑤正常供者比患者有较高的AUC即自我更新，特别是在G－CSF组比患者具有显著差异（P＝0．0067）。     

Kinetics of peripheral blood mononuclear cell mobilization with chemotherapy and/or granulocyte-colony-stimulating factor: implications for yield of hematopoietic progenitor cell collections

BACKGROUND: Peripheral blood progenitor cells (PBPCs) are commonly collected and used to reconstitute hematopoiesis after high-dose chemotherapy. However, strategies for optimal collection and assessment of leukapheresis components are not standardized. STUDY DESIGN and METHODS: Hematopoietic progenitor cell assays were performed on 369 leukapheresis components collected from 95 patients who had received doxorubicin-based chemotherapy and/or granulocyte-colony-stimulating factor (G-CSF). Precollection patient hematologic values, leukapheresis collection values, component hematopoietic progenitor cell assays, and patient outcome measures were summarized. The kinetics of mononuclear cell (MNC) and PBPC mobilization were assessed among four patient groups. RESULTS: Patient group was a significant predictor of the peripheral blood MNC count on the day of collection (p<0.0001), and that value was a significant predictor of granulocyte-macrophage– colony-forming unit (CFU-GM) yield (p<0.0001). This relationship between the peripheral blood MNC count on the day of collection and CFU- GM yield differed according to patient group (p<0.0001). CFU-GM made up a larger fraction of peripheral blood MNCs collected from patients who received chemotherapy plus G-CSF than collected from those who received G-CSF alone. Moreover, the peripheral blood MNC count and the corresponding CFU-GM yield increased significantly on consecutive days of collection in patient groups receiving chemotherapy and G-CSF but were unchanged or decreased in patients receiving G-CSF alone. CONCLUSION: The relationship between peripheral blood MNC count and leukapheresis component CFU-GM yield differed significantly between patients who received chemotherapy and G-CSF and those who received G- CSF alone for the mobilization of PBPCs. Patient peripheral blood MNC count and component CFU-GM yield are useful for both assessing and suggesting revisions to PBPC mobilization and collection strategies.     

Successful mobilization of peripheral blood HPCs with G-CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU-GM with chemotherapy and G-CSF

BACKGROUND: Mobilization with chemotherapy and G-CSF may result in poor peripheral blood HPC collection, yielding <2 x 10(6) CD34+ cells per kg or <10 x 10(4) CFU-GM per kg in leukapheresis procedures. The best mobilization strategy for oncology patients remains unclear. STUDY DESIGN AND METHODS: In 27 patients who met either the CD34 (n = 3) or CFU-GM (n = 2) criteria or both (n = 22), the results obtained with two successive strategies-that is, chemotherapy and G-CSF at 10 microg per kg (Group 1, n = 7) and G-CSF at 10 microg per kg alone (Group 2, n = 20) used for a second mobilization course-were retrospectively analyzed. The patients had non-Hodgkin's lymphoma (5), Hodgkin's disease (3), multiple myeloma (5), chronic myeloid leukemia (1), acute myeloid leukemia (1), breast cancer (6), or other solid tumors (6). Previous therapy consisted of 10 (1-31) cycles of chemotherapy with additional chlorambucil (n = 3), interferon (n = 3), and radiotherapy (n = 7). RESULTS: The second collection was undertaken a median of 35 days after the first one. In Group 1, the results of the two mobilizations were identical. In Group 2, the number of CD34+ cells per kg per apheresis (0.17 [0.02-0.45] vs. 0.44 [0.11-0.45], p = 0. 00002), as well as the number of CFU-GM (0.88 [0.00-13.37] vs. 4.19 [0.96-21.61], p = 0.00003), BFU-E (0.83 [0.00-12.72] vs. 8.81 [1. 38-32.51], p = 0.00001), and CFU-MIX (0.10 [0.00-1.70] vs. 0.56 [0. 00-2.64], p = 0.001134) were significantly higher in the second peripheral blood HPC collection. However, yields per apheresis during the second collection did not significantly differ in the two groups. Six patients in Group 1 and 18 in Group 2 underwent transplantation, and all but one achieved engraftment, with a median of 15 versus 12 days to 1,000 neutrophils (NS), 22 versus 16 days to 1 percent reticulocytes (NS), and 26 versus 26 days to 20,000 platelets (NS), respectively. However, platelet engraftment was particularly delayed in many patients. CONCLUSION: G-CSF at 10 microg per kg alone may constitute a valid alternative to chemotherapy and G-CSF to obtain adequate numbers of peripheral blood HPCs in patients who previously failed to achieve mobilization with chemotherapy and G-CSF. This strategy should be tested in prospective randomized trials.     

Kinetics of G-CSF-induced granulocyte mobilization in healthy subjects: effects of route of administration and addition of dexamethasone

BACKGROUND: Granulocyte donors are frequently given G-CSF with or without dexamethasone approximately 18 hours before apheresis to increase cell yields. The purpose of this study was to assess the kinetics of G-CSF plus dexamethasone neutrophil mobilization to determine whether the neutrophils can be mobilized and collected the same day. STUDY DESIGN AND METHODS: Sixteen subjects were given four separate mobilization regimens: IV G-CSF (5 microg/kg), subcutaneous G-CSF (5 microg/kg), IV G-CSF (5 microg/kg) plus oral dexamethasone (8 mg), and subcutaneous G-CSF (5 microg/kg) plus oral dexamethasone (8 mg). Blood cell counts were measured before and after G-CSF administration. RESULTS: Following all four mobilization regimens, neutrophil counts fell 0.5 hour after the mobilizing agents were given, rose above baseline levels at Hour 2, and increased further with each time interval to Hour 8. In the absence of dexamethasone at Hours 2 through 8, there was no difference in neutrophil counts by subcutaneous or IV G-CSF administration routes. The addition of dexamethasone enhanced mobilization of neutrophils from Hours 3 through 24. Through Hour 8, there was no difference in the degree of mobilization among the subcutaneous G-CSF plus dexamethasone and the IV G-CSF plus dexamethasone regimens. However, at Hour 24, neutrophil counts were sustained at higher levels with subcutaneous G-CSF plus dexamethasone than with IV G-CSF plus dexamethasone. CONCLUSIONS: Granulocyte mobilization response to subcutaneous G-CSF plus dexamethasone is sustained at peak levels for 8 to 24 hours after coadministration of the two drugs. There was no advantage to giving G-CSF intravenously.     

Selection of the mobilization regimen in lymphoma patients: A retrospective cohort study

Background and objectivesConsolidation with autologous stem cell transplantation (ASCT) is recommended for patients with recurrent or refractory lymphoma after salvage chemotherapy. Stem cells which will be used in ASCT are provided by mobilization using granulocyte colony stimulation factor (G-CSF) or chemotherapy plus G-CSF. The aim of this study was to compare the effect of various mobilization regimens on the clinical parameters of lymphoma patients.Materials and methodsMobilization interventions of lymphoma patients were analysed retrospectively. The patients were divided into 3 groups according to the mobilization method implemented to collect stem cells before ASCT, (Group 1: Salvage chemotherapy plus G-CSF, Group 2: Cyclophosphamide plus G-CSF, Group 3: G-CSF alone).ResultsAnalysis of CD34⁺ cell counts of the 3 groups revealed a significant difference (p < 0.001). Although the number of CD34⁺ cells collected were different, the neutrophil and platelet engraftment of the 3 groups were similar (p > 0.05). Furthermore, the results were similar in the separate analysis of NHL and HL patients. While the mobilization success rate in group 1 was 97.8 %, it was 90.2 % in group 3. This difference showed a certain trend towards statistical significance (p = 0.074). Patients who received DHAP plus G-CSF had a higher CD34⁺ count, while neutrophil engraftment was shorter than with ESHAP plus G-CSF (p < 0.05).ConclusionAlthough the success rate of mobilization and number of CD34⁺ cell collected were higher in the salvage chemotherapy plus G-CSF than G-CSF alone, G-CSF alone group provided similar neutrophil and thrombocyte engraftment in most lymphoma patients.     

The effect of cholesterol levels on hematopoietic stem cell mobilization

Data regarding effects of cholesterol levels on hematopoietic stem cell mobilization are limited. We retrospectively reviewed the relationship between serum total cholesterol levels and peripheral blood CD34 (PBCD34) cell counts in 52 granulocyte colony stimulating factor (G-CSF) induced mobilization cycles with or without chemotherapy. The cholesterol levels between the poor and good mobilization groups (median 172mg/dl vs. 183.5mg/dl, respectively, p=0.18) were not different. No significant correlation was obtained between the cholesterol levels and PBCD34 counts (r=0.02, p=0.85). No significant correlation was obtained between cholesterol levels and PBCD34 counts in patients neither mobilized with G-CSF alone (r=-0.02, p=0.9) nor G-CSF plus chemotherapy (r=0.04, p=0.8). The results of the study indicate that there was no effect of cholesterol on hematopoietic stem cell mobilization. Prospective cohort studies are needed to demonstrate the effect of cholesterol on mobilization and its extent in humans.     

Application of whole blood and peripheral blood progenitor cells (PBPC) and new strategies for rescue after intensive cyclic chemotherapy in high-risk breast cancer

The efficacy of autologous peripheral stem cells given as mobilized whole blood or leukapheresis product for hematopoietic rescue after intensive chemotherapy was studied in 34 consecutive female patients with high-risk breast cancer. All patients received six cycles of chemotherapy regimen EC (epirubicin 150 mg/m2 and cyclophosphamide 1250 mg/m2) at 14-day intervals. In the first cycle, chemotherapy was given on day 1, and 24 h later mobilization of PBPC was started with G-CSF at a dose of 5 microg/kg/day for 13 days. In all other cycles, G-CSF was given at the same dose from day 7. On days 11, 12, and 13, leukaphereses were performed, and whole blood was collected on day 14 (the peak incidence of colony-forming units-granulocyte-macrophage [CFU-GM] burst-forming units-erythrocyte [BFU-E], and colony-forming unit-granulocyte-erythrocyte-macrophage-megakaryocyte [CFU-GEMM]). The second cycle of chemotherapy was started on day 15, and 24 h later, whole blood (collected in the first cycle) was reinfused, and the same was done in the third cycle. In the fourth to sixth chemotherapy cycles, leukapheresis product was used for hematopoietic rescue. The median increment of absolute values in both whole blood and leukapheresis product was as follows: CD34+ cells over baseline was approximately 17.4-fold, CFU-GM was 85.3-fold, BFU-E was 95.9-fold, and CFU-GEMM was 44.2-fold. In the cycles with whole blood support, the mean values of applied progenitors per cycle were CD34+ cells 1.52 x 10(6)/kg, CFU-GM, 1.18 x 10(5)/kg, BFU-E 2.54 x 10(5)/kg, CFU-GEMM 0.31 x 10(5)/kg. In the courses with PBPC support, the mean values of progenitors were CD34+ 2.04 x 10(6)/kg, CFU-GM 1.59 x 10(5)/kg, BFU-E 2.87 x 10(5)/kg, and CFU-GEMM 0.34 x 10(5)/kg. Leukopenia in patients supported with whole blood versus leukapheresed PBPC was as follows: grade 4, 13/6 (38.2%/17.6%), grade 3, 19/23 (55.9%/70.6%), and grade 2, 1/4 (2.9%/11.8%), respectively. Thrombocytopenia was grade 4, 11/6 (32.4%/17.6%), grade 3, 10/7 (29.4%/20.6%), grade 2, 7/13 (20.6%/38.2%), and grade 1, 6/6 (17.6%/17.6%), respectively. The median follow-up analysis was at 24.6 (7-36) months. High-risk patients previously treated with surgery and adjuvant chemotherapy (n = 5) were not evaluated for response. In 21 patients with locally advanced or inflammatory breast carcinoma the response rate (RR) was 94%, CR was 90%, and PR was 15%. No response to therapy was observed in 1 patient. In 8 patients with metastatic disease, RR was 75%, there was no CR, and PR was 75%. Two patients died during therapy. Relapse-free survival (RFS) in the adjuvant group was 23.7 (range 12-36) months and in the group with locally advanced disease was 18.2 (range 7-27) months. In the group with metastatic disease, time to tumor progression (TTP) was 12.1 (range 1-16) months. Mean duration of hospital stay for whole blood reinfusion in the second and third chemotherapy cycles was 6.7 (range 5-8) days and for PBPC in the fourth to sixth cycles was 6.2 (range 4-8) days, which at p < 0.001 was not statistically significant.     

Plerixafor use in patients with previous mobilization failure: A multicenter experience

Plerixafor in conjunction with G-CSF (G-P) is an effective strategy for hematopoietic stem cell mobilization in patients with previously failed mobilization attempt. Here we report our results with G-P among patients with at least one mobilization failure with G-CSF alone (G) or G-CSF plus chemotherapy (G-C). The study included 20 consecutive patients with lymphoma and myeloma from five centers. In 14 (70%) patients, a minimum of 2×10(6)/kg CD34+ stem cells were collected and 16 out of 20 patients (80%) were able to proceed to ASCT. Our study indicates that plerixafor can safely rescue patients with a history of mobilization failure.     

CD34+ cell adhesion molecule profiles differ between patients mobilized with granulocyte-colony-stimulating factor alone and chemotherapy followed by granulocyte-colony-stimulating factor

BACKGROUND: High-dose therapy with autologous peripheral blood progenitor cell support is widely utilized but requires successful CD34+ cell mobilization and collection. Chemotherapy plus growth factors appear to mobilize more CD34+ cells than growth factors alone. Because alterations in expression of adhesion molecules are important in the trafficking of hematopoietic progenitors, the possibility was explored that the mechanism of this superior mobilization may be greater down regulation of adhesion molecules. STUDY DESIGN AND METHODS: The expression of eight adhesion molecules (CD11a, b, and c; 15s; 49d and e; 54; and 62L) on the collected CD34+ cells from 15 patients undergoing mobilization with chemotherapy plus granulocyte-colony-stimulating factor (G-CSF) was compared with those of 14 concomitant patients receiving G-CSF alone. RESULTS: Patients receiving chemotherapy plus G-CSF mobilized more CD34+ cells and did not differ in prior chemotherapy or radiation. There were no significant differences in the percentage of CD34+ cells expressing any of the adhesion molecules examined between the two groups. The chemotherapy plus G-CSF-mobilized cells consistently showed higher expression intensity, and this showed significance or a strong trend for CD11a and c, CD15s, and CD54. Despite these higher expression levels, there were no differences in engraftment kinetics. CONCLUSIONS: CD34+ cells mobilized by chemotherapy plus growth factors appear to have higher intensities of expression of several adhesion molecules. The significance of this observation will require further study.     

米托蒽醌、阿糖胞苷、粒细胞集落刺激因子的动员方案及大容量采集自体外周血干细胞

背景:外周血干细胞移植成功的首要条件是干细胞的有效动员和采集,选择高效低毒的动员方案,掌握动员和采集时机与动员效果密切相关。目的:探讨米托蒽醌-大剂量阿糖胞苷方案化疗后,单用粒细胞集落刺激因子或粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用对恶性血液病和实体瘤患者自体外周血干细胞的动员效果。设计:观察对比实验。单位:徐州医学院附属医院血液科。对象:选择1998-09/2006-12在徐州医学院附属医院血液科收治的42例恶性血液病和实体瘤患者,诊断符合国际白血病分型及世界卫生组织新分类标准。男25例,女17例,年龄7～54岁,平均29岁,体质量(52±18)kg。其中急性髓细胞白血病12例,急性淋巴细胞白血病6例,慢性粒细胞白血病慢性期1例,非霍奇金淋巴瘤15例,霍奇金淋巴瘤4例,多发性骨髓瘤2例,晚期乳癌2例。患者均经常规化疗达到或接近完全缓解,骨髓细胞学检查无肿瘤细胞浸润。心、肺、肝、肾等主要脏器功能正常。动员前化疗疗程平均8次,所有患者均对治疗项目知情同意。方法:患者均采用米托蒽醌10mg/(m2·d)静脉滴注第2～3d后,阿糖胞苷2g/m2静脉滴注第1～2d,1次/12h。当白细胞计数下降至最低点开始回升时,20例患者使用粒细胞集落刺激因子5～7.5μg/(kg·d),连用3～5d,22例患者早6:00给予粒细胞集落刺激因子5～7.5μg/(kg·d),晚6:00给予粒-巨噬细胞集落刺激因子5～7μg/(kg·d)。白细胞计数>2.5×109 L-1,CD34 细胞≥1%时,用CS3000plus血细胞分离机连续2d采集自体外周血干细胞,检测CD34 细胞含量和T淋巴细胞亚群。①单个核细胞与FITC标记的CD34 、CD3和CD8单抗及与CD4PE标记的CD4单抗4℃混合30min,采用流式细胞仪检测CD34 细胞和T细胞亚群,分析5×105个细胞,得出CD3、CD34 细胞含量及CD4/CD8比值。用甲基纤维素法测定粒-巨噬细胞集落形成单位。②观察术后相关不良反应。③针对不同类型疾病给予相应预处理36～48h后回输自体外周血干细胞,并行单个核细胞计数及台盼蓝染色,解冻后检测粒-巨噬细胞集落形成单位和CD34 细胞。主要观察指标:①动员前后CD34 细胞和T细胞亚群变化。②术后相关不良反应。③自体外周血干细胞回输量(单个核细胞计数、粒-巨噬细胞集落形成单位和CD34 细胞数)。结果:纳入患者42例,均进入结果分析。①动员前后CD34 细胞和T细胞亚群变化:患者应用粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子动员后外周血CD34 细胞明显增加[(0.054±0.032)%,(1.82±0.76)%,P<0.01]。22例联合应用粒细胞集落刺激因子和粒-巨噬细胞集落刺激因子动员患者CD34 细胞和粒-巨噬细胞集落形成单位分别为(8.76±3.39)×106/kg,(3.52±1.33)×105/kg,明显高于单用粒细胞集落刺激因子的20例患者[(6.12±2.11)×106/kg,(2.03±1.07)×105/kg,P<0.05]。单独应用粒细胞集落刺激因子及粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用后随CD34 细胞增加,T淋巴细胞亚群变化不明显(P>0.05)。②外周血干细胞动员相关不良反应:全部病例出现Ⅱ～Ⅲ度脱发,血小板均有不同程度的下降,为(54.43±26.14)×109 L-1,21例患者出现感染性发热(37.8～41.0℃),经抗生素治疗感染均在短期内得到控制。13例患者在白细胞快速上升时出现骨骼疼痛(腰骶部为主)。③自体外周血干细胞回输量:自体外周血干细胞非程控冷冻-80℃保存2.0～6.5个月,细胞回收率(88.7±7.4)%,台盼蓝拒染率(92.1±5.5)%,回输的单个核细胞(5.21±2.44)×108/kg,CD34 细胞(6.89±3.55)×106/kg,粒-巨噬细胞集落形成单位(2.58±2.33)×105/kg。④循环血量每次10～16L(终点分血量均在3个TBV上)。无严重毒副反应。26例接受自体外周血干细胞移植者造血功能均获得满意重建。结论:米托蒽醌-大剂量阿糖胞苷方案化疗后单用粒细胞集落刺激因子及粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子合用均能安全、有效动员自体外周血干细胞,但以合用更为有效。大容量采集是提高干细胞产率,减少采集次数的重要手段。