COAEP联合粒细胞集落刺激因子动员及采集造血干细胞在自体外周血干细胞移植中的应用

目的：探讨COAEP化疗方案联合粒细胞集落刺激因子（G-CSF）治疗对血液病患者外周血干细胞（PBSC）动员的效果。方法：选择恶性血液病患者24例，其中非霍奇金淋巴瘤（NHL）15例，多发性骨髓瘤（MM）6例，霍奇金病（HD）3例？以COAEP方案动员dl（第1天）：环磷酰胺（CTX）400mg／m^2，长春地辛（VDS）2mg/m^2；dl-5应用阿糖胞苷（Ara—C）60mg／m^2．依托泊甙（VP-16）60mg／m^2，泼尼松（Pred）30mg／m^2]。将患者随机分为试验组和对照组。试验组取患者化疗后白细胞抑制达最低点开始稳定回升（第二次回升）时为节点．予G-CSF（惠尔血）300μg／d；而对照组以动员方案结束后向细胞跌至低谷首次回升时即使用G—CSF300μg/d。2组患者开始使用G—CSF后每日查血常规，当白细胞计数〉10．0×10^9／L和单个核细胞（MNC）计数〉1．0×10^9/L时使用COBE血细胞分离机，以自动单个核细胞分离程序采集PBSC．结果：使用COAEP方案动员后，24例恶性血液病患者平均获得的CD34＋细胞数达每例17．25×10^6/kg。试验组患者平均使用G—CSF的时间为4．17d，采集PBSC次数为1～2次，采集液CD34＋细胞数为每例11．73×10^6/kg（何均值）：对照组患者平均使用G—CSF的时间为5．92d，采集PBSC次数为1～2次，采集液CD34＋细胞数为每例1．79×10^6/kg（几何均值），2组间差异有统计学意义（P〈0．0028），结论：COAEP联合化疗可作为血液病患者自体PBSC动员的方案，并能获得良好的干细胞产率：患者白细胞开始稳定回升时使用G—CSF，可显著提高PBSC产率：根据患者外同血白细胞计数及单个核细胞数决定PBSC采集时机有效可行，值得临床推广。

Mobilization and collection of peripheral blood stem cells with COAEP plus G-CSF regimen in autologous peripheral blood stem cell transplantation

Objective To investigate the effect of COAEP plus G-CSF on the mobilization of peripheral blood stem cells in bematologieal disease patients. Methods Twenty-four malignant hematological disease patients were enrolled, including 15 cases of non-Hodgkin＇s lymphoma, 6 cases of multiple myeloma and 3 cases of Hodgkin＇s disease. Mobilization chemotherapy regimen was COAEP： cyclophosphamide 400 mghn2, vindesine 2 mg/m^2, cytosine arabinoside 60 mg/m^2×5 d, etoposide 60 mg/m^2×5 d, and prednisone 30 mg/m^2×5 d. Patients were randomly assigned into experimental group and control group according to the time point of giving G-CSF. In experimental group, G-CSF 300 μg/d was given when the number of WBC began to increase stably （second rebound） after rebounding. G-CSF 300 μg/d was given in control group when the WBC started to rebound after reaching the nadir. The routine blood cell count was checked daily after giving G-CSF, and CD34＋ blood cell was collected by apheresis when peripheral WBC〉10.0×10^9/L, MNC〉1.0×10^9/L and immature cells emerged in peripheral WBC. Leukapheresis was performed with COBE blood cell separator using separate MNC process. Results By using the COAEP regimen, an average of 17.25×10^6/kg CD34＋ cell was collected. The experimental group used G-CSF for 4.67 days and had 11.73×10^6/kg （geomean） CD34＋ cell collected in 1-2 collections： the control group used G-CSF for 5.92 days and had 1.79×10^6/kg （geomean） CD34＋ cell collected in 1-2 collections. The difference between the two groups was statistically significant （P〈0.0028）. Conclusions COAEP was effective as a mobilizing regimen for stem cell collection. Giving G-CSF when WBC began to increase stably （second rebound） could elevate the CD34＋ cell yield significantly. Determining the time of harvesting stem cells by the account ofperipheral blood WBC and MNC is feasible and could be used in practice.