健康供者外周血造血干细胞动员的临床研究

目的:探讨造血生长因子(HGFs)对健康供者外周血干细胞(PBSC)的动员作用,并比较粒细胞集落刺激因子(G-CSF)单用及G-CSF联合粒-巨噬细胞集落刺激因子(GM-CSF)的动员效果.方法:52例健康供者分成G-CSF单用组(34例)及与GM-CSF合用组(18例),分别采用G-CSF(5 μg·kg-1·d-1)及G-CSF(3 μg·kg-1·d-1)+GM-CSF(2 μg·kg-1·d-1),连续皮下注射5～6 d动员,采集PBSC.动员前后动态检测外周血及采集物MNC、CD34+细胞、CFU-GM计数.52例血液病患者接受上述供体动员之PBSC并行异基因PBSC移植(Allo-PBSCT).结果:动员后CD34+细胞及CFU-GM分别较动员前增加10.83及8.7倍,并在第5～6天达到高峰;G-CSF单用及与GM-CSF合用均可有效动员CD34+细胞和CFU-GM,但合用较单用更有效(P<0.05);所有患者接受Allo-PBSCT后均满意获得造血重建;随访观察至今应用HGFs对健康供者无明显不良反应.结论:采用中小剂量G-CSF单用和与GM-CSF合用均能安全、有效动员健康供者PBSC,但以合用更为有效.

Clinical study on peripheral blood stem cell mobilization in normal donors

Objective: To explore the efficiency of hematopoietic growth factors (HGFs) on peripheral blood stem cell (PBSC) mobilization in normal donors. Methods: Granulocyte-colony stimulating factor (G-CSF, 5 μg·kg-1·d-1) was used subcutaneously in 34 donors and G-CSF (3 μg·kg-1·d-1) + granulocyte-macrophage-colony stimulating factor (GM-CSF,2 μg·kg-1·d-1) in 18 donors for 5-6 d. PBSC was harvested with CS-3000 Plus or COBE Spectra blood cell separator. The numbers of MNC, CD34+ cells and CFU-GM were determined during the mobilization. Fifty-two patients with hematologic disease received allogeneic peripheral blood stem cell transplantation (Allo-PBSCT). Results: After mobilization, CD34+ cells and CFU-GM yields increased by 10.83 and 8.7 folds, respectively, and peaked on day 5 of HGFs initiation. Both G-CSF alone and G-CSF + GM-CSF effectively mobilized PBSC, while G-CSF+GM-CSF mobilized CD34+cells and CFU-GM more efficiently than G-CSF alone(P<0.05). Hematopoiesis was well reconstituted in all the patients. No severe toxicity was observed in the normal donors. Conclusion: Our data suggests that both G-CSF alone and G-CSF+GM-CSF at a low dose of 5 μg*kg-1*d-1 can safely and effectively mobilize PBSC, while G-CSF+GM-CSF is superior to G-CSF alone.