造血系统恶性肿瘤自体外周血干细胞动员采集和冻存研究

目的:探讨造血系统恶性肿瘤自体外周血造血干细胞移植(APBSCT)后造血系统重建与采集和冻存自体的外周血干细胞(APBSC)数量及质量的关系。方法:用大剂量化疗加粒细胞集落刺激因子(G-CSF)方法对拟行APBSCT的18例造血系统恶性肿瘤进行动员,CS-3000PLUS血细胞分离机采集APBSC,经程序降温仪处理保存于-196℃液氮中,37~40℃水浴解冻后迅速回输,检测冻存前及解冻后APBSC的锥虫蓝染色拒染率、单个核细胞(MNC)计数、粒-单集落形成单位(CFU-GM)集落数及CD34 细胞百分率。结果:APBSC的采集时间为化疗后12.6(9~19)d,采集次数2.4(1~3)次,MNC采集率为(138.6±52.32)%。解冻后MNC、CD34 及CFU-GM的回收率分别为(91.96±1.37)%,(85.94±0.64)%,(87.69±4.53)%。冻存前及解冻后APBSC的锥虫蓝染色拒染率分别为(96.26±1.33)%,(92.75±2.04)%,二者差别无统计学意义(P>0.05)。骨髓瘤患者CFU-GM集落数、MNC采集率及CD34 细胞百分率较低;化疗疗程>10次的5例患者MNC采集率较低及CFU-GM生长不良,其中3例出现APBSCT后造血重建延迟。结论:rhG-CSF与大剂量化疗联合的动员方案可缩短采集时间,提高MNC采集率;APBSC的质量和数量有显著的个体差异,与疾病的类型和化疗方案有密切关系,移植前化疗次数增多可影响APBSC的数量和质量,导致APBSCT后造血重建延迟。     

捐献外周血造血干细胞供体的安全问题

造血干细胞移植越来越多地用于治疗血液系统恶性疾病、血红蛋白病、实体瘤以及自身免疫性疾病.目前每年约有15000例供体为异基因干细胞移植患者提供造血干细胞.     

异基因外周血造血干细胞移植治疗白血病

我院从１９９６年４月至１９９８年７月,用异基因外周血干细胞移植（ＡｌｌｏＰＢＳＣＴ）成功地治疗了１５例白血病患者。一、资料与方法１－病例：１５例患者中急性髓细胞白血病（ＡＭＬ）８例,急性淋巴细胞白血病（ＡＬＬ）５例,慢性粒细胞白血病（ＣＭＬ）慢性期２例;急性白血病１２例处在完全缓解期（ＣＲ）,１例为第３次复发。男１１例,女４例,年龄１４～４９岁,中位数３９岁。２－供体：１４例系患者的同胞,ＨＬＡＡ、Ｂ及ＤＲ配型完全相合１３例,ＨＬＡ－Ａ位点不合１例,母亲供体１例,ＨＬＡＢ位点不相合。ＡＢＯ…     

外周血造血干细胞移植中出血性膀胱炎的预防

出血性膀胱炎(hemorrhagic cystitis,HC)是外周血造血干细胞移植(peripheral blood stem cell transplantation,PBSCT)中常见的并发症。我们采用PBSCT治疗急、慢性白血病23例,在预处理过程中采取了一定的预防措施,有效地预防了HC的发生,现报道如下。资料与方法一般资料1997年8月～2005年5月,收集我     

外周血造血干细胞体外保存的研究现状与进展

本文综述了近年来有关外周血造血干细胞体外保存方面的研究进展，讨论了保存温度和冷冻，解冻过程对造血干细胞增殖潜力的影响，细胞因子对冷冻造血干细胞增殖潜力的恢复作用以及低温冻存对造血干细胞免疫活性的影响。     

外周血造血干细胞与白细胞在脑外伤后的动态变化及意义

脑外伤患者38例,采用流式细胞仪、全自动血细胞分析仪动态检测第1、3、5、7、14天外周血CD34^＋的绝对值和白细胞的变化。结果显示,脑外伤后,轻症组、重症组均出现CD34^＋细胞逐步上升,重症组上升幅度较大;而白细胞值在伤后迅速升高并逐步下降,与CD34^＋细胞变化呈负相关。认为脑外伤后CD34^＋细胞与白细胞计数可作为重要观察指标,脑外伤后机体存在CD34^＋细胞的动员,参与脑外伤的修复。     

外周血造血干细胞移植治疗恶性血液病疗效观察

目的:观察外周血干细胞移植治疗恶性血液病的疗效、探讨移植相关并发症的预防及处理.方法:回顾分析了我院自2005年5月～2006年3月,其中2例采用HLA相合的同胞异基因外周血干细胞移植(AlloPBSCT),9例采用自体外周血造血干细胞移植(Auto-PBSCT).结果:全部病例均成功获得造血重建,中性粒细胞≥0.5×109/L,平均时间为11.3 d,血小板≥20×109/L平均时间为16.3 d;无严重并发症发生,无严重GVHD发生,中位随访时间11(2～24)个月,无复发及死亡病例.结论:外周血干细胞移植是治疗恶性血液病安全、有效的方法.     

造血系统恶性肿瘤外周血干细胞分离冻存及其临床应用

报告应用Ｈａｅｍｏｎｅｔｉｃｓ Ｖ５０ ＰＬＵＳ血细胞分离机对４种造血系统恶性肿瘤病人进行外周血干细胞采集，冻存的结果，第１次完全缓解早期４例病 均能收集到足够的外周血干细胞量进行自体移植，１例病人静脉应用动员剂ＧＭ－ＣＳＦ能提高外周血干细胞的采集效率，初步观察到化疗药物的累积损害对外周血干细胞的采集有不利影响。     

10例恶性肿瘤患者外周血造血干细胞采集过程中的护理干预

外周血造血干细胞采集操作简单,要保质保量的获得造血干细胞,护理干预到位至关重要。近年来,我们对10例恶性肿瘤患者采集外周造血干细胞,现将护理干预要点及体会报告如下。     

同种异基因外周血干细胞移植后造血功能的快速重建

同种异基因外周血干细胞移植后造血功能的快速重建陈虎江岷胡亮钉王波闫安文刘传芳曹履先邓春江刘键１９８９年国外首先报告［１］同种异基因外周血干细胞移植（ａｌｏ－ＰＢＳＣＴ）治疗白血病以来，目前全世界共报道了２００余例。其主要优点在于：（１）造血功能重建速...     

供者外周血干细胞输注预防高危白血病单倍型移植后复发的临床研究

Objective To explore the preventative effect of donor peripheral blood stem cell (PBSC) infusion mobilized by granulocyte colony-stimulating factor (G-CSF) for the relapsing patients with leukemia after haplotype hematopoietic stem cell transplantation ( HSCT) , as well as its therapeutic effect and safety. Methods G-CSF was given at 5-10 μg · kg-1 · d-1 to donor and PBSCs were obtained on day 5 and frozen and allotted for storing. PBSC infusion was given to all the 20 patients on day 90 after HSCT,and the second treatment was given to 4 patients on day 30 after the first infusion. The occurrence of graftversus-host disease ( GVHD) , relapse rate of high risk leukemia and long-term survival were evaluat after PBSC infusion. Results A total of 19 patients had acute GVHD after PBSC infusion for a median of 25 (12-60) months, 4 of them were ≥ degree Ⅲ. The cumulative incidence rate was 22.9%, and all of them accepted PBSC infusion twice. Thirteen patients had assessable chronic GVHD, 10 of them were restricted,and no one died of it. Nine patients died of relapse of leukemia. The remaining 11 patients survived leukemia free, including 4 with chronic myelogenous leukemia, 4 with acute myeloid leukemia (AML) , 1 with lymphoma-leukemia and 2 with myelodysplastic syndrome-AML (MDS-AML). Kaplan-Meier analysis showed the disease free survival rate of 2-year was 52. 5%. Conclusion The prophylactic donor PBSC infusion mobilizing with G-CSF is effective, safe and feasible for the relapse of leukemia.     

供者外周血干细胞输注预防高危白血病单倍型移植后复发的临床研究

Objective To explore the preventative effect of donor peripheral blood stem cell (PBSC) infusion mobilized by granulocyte colony-stimulating factor (G-CSF) for the relapsing patients with leukemia after haplotype hematopoietic stem cell transplantation ( HSCT) , as well as its therapeutic effect and safety. Methods G-CSF was given at 5-10 μg · kg-1 · d-1 to donor and PBSCs were obtained on day 5 and frozen and allotted for storing. PBSC infusion was given to all the 20 patients on day 90 after HSCT,and the second treatment was given to 4 patients on day 30 after the first infusion. The occurrence of graftversus-host disease ( GVHD) , relapse rate of high risk leukemia and long-term survival were evaluat after PBSC infusion. Results A total of 19 patients had acute GVHD after PBSC infusion for a median of 25 (12-60) months, 4 of them were ≥ degree Ⅲ. The cumulative incidence rate was 22.9%, and all of them accepted PBSC infusion twice. Thirteen patients had assessable chronic GVHD, 10 of them were restricted,and no one died of it. Nine patients died of relapse of leukemia. The remaining 11 patients survived leukemia free, including 4 with chronic myelogenous leukemia, 4 with acute myeloid leukemia (AML) , 1 with lymphoma-leukemia and 2 with myelodysplastic syndrome-AML (MDS-AML). Kaplan-Meier analysis showed the disease free survival rate of 2-year was 52. 5%. Conclusion The prophylactic donor PBSC infusion mobilizing with G-CSF is effective, safe and feasible for the relapse of leukemia.     

供者外周血干细胞输注预防高危白血病单倍型移植后复发的临床研究

Objective To explore the preventative effect of donor peripheral blood stem cell (PBSC) infusion mobilized by granulocyte colony-stimulating factor (G-CSF) for the relapsing patients with leukemia after haplotype hematopoietic stem cell transplantation ( HSCT) , as well as its therapeutic effect and safety. Methods G-CSF was given at 5-10 μg · kg-1 · d-1 to donor and PBSCs were obtained on day 5 and frozen and allotted for storing. PBSC infusion was given to all the 20 patients on day 90 after HSCT,and the second treatment was given to 4 patients on day 30 after the first infusion. The occurrence of graftversus-host disease ( GVHD) , relapse rate of high risk leukemia and long-term survival were evaluat after PBSC infusion. Results A total of 19 patients had acute GVHD after PBSC infusion for a median of 25 (12-60) months, 4 of them were ≥ degree Ⅲ. The cumulative incidence rate was 22.9%, and all of them accepted PBSC infusion twice. Thirteen patients had assessable chronic GVHD, 10 of them were restricted,and no one died of it. Nine patients died of relapse of leukemia. The remaining 11 patients survived leukemia free, including 4 with chronic myelogenous leukemia, 4 with acute myeloid leukemia (AML) , 1 with lymphoma-leukemia and 2 with myelodysplastic syndrome-AML (MDS-AML). Kaplan-Meier analysis showed the disease free survival rate of 2-year was 52. 5%. Conclusion The prophylactic donor PBSC infusion mobilizing with G-CSF is effective, safe and feasible for the relapse of leukemia.     

Platelet-released supernatants enhance hematopoietic stem cell proliferation in vitro

Peripheral blood stem cell transplantation (PBSCT) is used to reconstitute normal hematopoiesis after myeloablative chemotherapy. The hematopoietic stem cells are collected from the blood by apheresis machines using density gradient centrifugation. Because of density similarities the grafts contain high levels of leukocytes and platelets that release various mediators into the grafts. The collected hematopoietic stem cells are therefore exposed to platelet released mediators including platelet-derived growth factor, transforming growth factor-β, vascular endothelial growth factor and platelet factor-4. To investigate whether platelet activation and secretion can affect hematopoietic stem cells during PBSCT, we cultured (i) normal cord blood stem cells and (ii) mobilized peripheral blood stem cells from autografts together with the total secretion product of thrombin activated platelets (i.e. platelet released supernatants). Platelet released supernatants enhanced the cell proliferation of both peripheral blood stem cell (PBSC) autograft and normal cord blood CD34⁺ cells. Our study shows that platelet secretion in PBSCT autografts affect the hematopoietic stem cell function and possibly thereby the hematopoietic reconstitution after PBSCT.     

供者外周血干细胞输注预防高危白血病单倍型移植后复发的临床研究

目的 探讨供者粒细胞集落刺激因子(G-CSF)动员外周血干细胞输注对高危复发白血病患者单倍型移植后白血病复发的预防作用,评价其疗效及安全性.方法 对20例复发未缓解白血病患者在单倍型造血十细胞移植(HSCT)后给予预防性外周血干细胞输注,供者接受G.CSF 5～10μg·kg-1·d-1,分次注射,第5天采集外周血干细胞,在移植90 d后(+90 d)行第1次输注,30 d后4例患者行第2次输注,除1例第1次输注的单个核细胞数(MNC)为0.1×108个/kg外,其他患者均为0.2×108个/kg.外周血千细胞输注后观察移植物抗宿主病(GVHD)的发生、白血病复发率及患者长期生存的情况.结果 外周血干细胞输注后,中位随访25(4～印)个月,19例患者发生急性GVHD,其中Ⅲ度以上4例,累积发生率22.9%,均是接受2次输注的患者;可以评价的慢性GVHD13例,其中10例为局限性慢性GVHD.无患者因GVHD死亡.9例患者复发死亡,其余11例患者无病生存,其中4例慢性髓性白细胞、4例急性髓性白细胞(AML)、1例淋巴瘤性白血病、2例骨髓增生异常综合征转AML,Kaplan-Meier生存计算2年无病生存率为52.5%.结论 G-CSF动员外周血干细胞输注预防单倍型HSCT后白血病复发,效果显著,安全性较好.

Abstract：

Objective To explore the preventative effect of donor peripheral blood stem cell (PBSC) infusion mobilized by granulocyte colony-stimulating factor (G-CSF) for the relapsing patients with leukemia after haplotype hematopoietic stem cell transplantation ( HSCT) , as well as its therapeutic effect and safety. Methods G-CSF was given at 5-10 μg · kg-1 · d-1 to donor and PBSCs were obtained on day 5 and frozen and allotted for storing. PBSC infusion was given to all the 20 patients on day 90 after HSCT,and the second treatment was given to 4 patients on day 30 after the first infusion. The occurrence of graftversus-host disease ( GVHD) , relapse rate of high risk leukemia and long-term survival were evaluat after PBSC infusion. Results A total of 19 patients had acute GVHD after PBSC infusion for a median of 25 (12-60) months, 4 of them were ≥ degree Ⅲ. The cumulative incidence rate was 22.9%, and all of them accepted PBSC infusion twice. Thirteen patients had assessable chronic GVHD, 10 of them were restricted,and no one died of it. Nine patients died of relapse of leukemia. The remaining 11 patients survived leukemia free, including 4 with chronic myelogenous leukemia, 4 with acute myeloid leukemia (AML) , 1 with lymphoma-leukemia and 2 with myelodysplastic syndrome-AML (MDS-AML). Kaplan-Meier analysis showed the disease free survival rate of 2-year was 52. 5%. Conclusion The prophylactic donor PBSC infusion mobilizing with G-CSF is effective, safe and feasible for the relapse of leukemia.     

Allogeneic hematopoietic stem cell transplantation

More than 30 years have passed since the first clinical application of allogeneic bone marrow transplantation to treat hematological diseases. In recent years, the availability of peripheral blood and cord blood as additional sources of stem cells other than bone marrow has expanded the applicability of hematopoietic stem cell transplantation. In addition to differences in stem cell content, immune cells in the grafts from the three sources are different in quality and quantity. As a consequence, transplants from different sources have different kinetics of hematological recovery. Stem cell sources also influence risks for developing graft-versus-host disease. In this paper, we review recently reported results of thus diversified allogeneic hematopoietic, stem cell transplantation.     

Cotransplantation of HLA-identical mesenchymal stem cells and hematopoietic stem cells in Chinese patients with hematologic diseases

Mesenchymal stem cells (MSCs) may be employed to support hematopoietic reconstitution and mitigate graft-vs.-host disease (GVHD) in transplantation of hematopoietic stem cells (HSCs). The aim of this study was to explore the feasibility and safety of cotransplantation culture-expanded MSCs and HSCs from the same human leukocyte antigen (HLA)-identical sibling donor in Chinese patients with hematologic diseases. Bone marrow mononuclear cells from healthy donors were cultured and expanded ex vivo. Immunophenotype, adipogenic and osteogenic differentiation potential, and karyotype of the harvested MSCs were detected on those who had been cotransplanted with HSCs and MSCs from the same donor. Hematopoietic reconstitutions, complications, and clinical outcomes were observed after cotransplantation in these patients. (1.77 ± 0.40) × 10⁶/kg (donor’s weight) MSCs were successfully expanded from 23.6 ± 5.96 ml of bone marrow samples. They had normal karyotypes with bi-lineages differentiation potential, and were CD73, CD90, and CD105 positive. Twelve patients underwent cotransplantation with no observable adverse response during and after the infusion of MSCs. Hematopoietic reconstitutions were rapid. Two patients developed grade II–IV acute GVHD, and two extensive chronic GVHD. Four patients suffered from cytomegalovirus infection but were cured eventually. Up to now, seven patients have been followed as long as 29–57 months and five patients died. It is concluded that MSCs can be expanded effectively by culture and it is safe and feasible to cotransplant patients with allogenic culture-expanded MSCs and HSCs.     

脐血干细胞治疗缺血性卒中

缺血性卒中是目前全球致死率和致残率最高的主要疾病之一.传统治疗方法(如溶栓治疗)存在时间窗窄、疗效不佳等缺陷.脐血干细胞移植作为一种细胞治疗,为难治性神经系统疾病的治疗带来希望.     

脐血干细胞治疗缺血性卒中

缺血性卒中是目前全球致死率和致残率最高的主要疾病之一.传统治疗方法(如溶栓治疗)存在时间窗窄、疗效不佳等缺陷.脐血干细胞移植作为一种细胞治疗,为难治性神经系统疾病的治疗带来希望.     

脐血干细胞治疗缺血性卒中

缺血性卒中是目前全球致死率和致残率最高的主要疾病之一.传统治疗方法(如溶栓治疗)存在时间窗窄、疗效不佳等缺陷.脐血干细胞移植作为一种细胞治疗,为难治性神经系统疾病的治疗带来希望.