供者用粒细胞集落刺激因子后骨髓细胞成分的变化及移植后临床分析

目的了解供者应用粒细胞集落刺激因子(G-CSF)后骨髓细胞成分的改变及移植后促造血重建和减轻移植物抗宿主病(GVHD)的疗效.方法供者应用(研究组)和未用G-CSF(对照组)各12例进行异基因骨髓移植,研究组供者接受G-CSF(Lenograstim) 250 μg/d 连用7 d后采髓,比较研究组和对照组植入物造血成分CD+34、粒-单细胞集落形成单位(CFU-GM)、巨核细胞集落形成单位(CFU-MK)和CD+3及亚群的改变,及移植后对造血重建和急性GVHD的影响.结果两组在采集大致相同体积的骨髓植入物中,研究组采集的有核细胞数(TNC),CD+34,CFU-GM和CFU-MK明显高于对照组(P＜0.01),两组CD+3类同,CD+4减少,CD+8增加(P＞0.05),CD+4/CD+8明显减少(P＜0.01).研究组和对照组骨髓CD+34和T淋巴细胞亚群百分数及CFU-GM与CFU-MK增殖进行分析,显示类似变化的结果.研究组移植后中性粒细胞>0.5×109/L的时间是16 d(11～23),血小板>20×109/L的时间为17 d(14～25),对照组分别为20.5 d(14～29)和23.0 d(17～32)(P＜0.05).研究组无1例发生急性Ⅱ～Ⅳ GVHD,对照组3例发生急性Ⅱ～Ⅳ GVHD,两组比较差异无显著性(P＞0.05).结论异基因骨髓移植供者应用G-CSF 可促进造血恢复作用,这与增加植入物中CD+34、CFU-GM和CFU-MK数量有关,具有降低急性重度GVHD发生的倾向.

Administration of leukemic granulocyte colony-stimulating factor to donors: the changes in donor bone marrow cell composition and the transplantation outcome

OBJECTIVE: To investigate the change of bone marrow cell composition the effect of graft on hemopoietic reconstitution and the incidence of acute graft-versus-host disease (aGVHD) with granulocyte colony-stimulating factor G-CSF administration to donors before marrow harvesting. METHODS: Twenty-four patients with myeloid leukemia underwent allogeneic bone marrow transplantation. The donors of twelve patients (study group) were given G-CSF 250 microg/d for seven days prior to harvesting. The marrow cell composition, the outcome of subsequent engraftment and the occurrence of aGVHD were compared with those in twelve patients without G-CSF (control group). RESULTS: The bone marrow stimulated by G-CSF yielded higher number of nucleated cells, CD34+ cells, CFU-GM and CFU-MK (P < 0.01). The number of T lymphocyte subsets in the graft stimulated with G-CSF was different from that in the control group. The number of CD4+ cells was decreased and that of CD8+ increased. The CD4+/CD8+ ratio was reduced markedly (P < 0.01). The change of CD34+, CD4+, CD8+ percentage and CFU-GM, CFU-MK proliferation in donor bone marrow with and without G-CSF was compared. The same characteristic change as above graft was observed. Hemopoietic reconstitution in the study group after allo-BMT was accelerated. In the study group the days of granulocyte count exceeding 0.5 x 10(9)/L and platelet count exceeding 20 x 10(9)/L were 16 days (range 11 - 23 days) and 17 days (range 14 - 25 days) (in the control group 20.5 day, range 14 - 29 days and 23 days, range 17 - 32 days P < 0.05). Grade II - IV aGVHD did not occur in patients of the study group but in 3 patients of the control group. CONCLUSION: The bone marrow harvested from donor with G-CSF stimulation can accelerate hemopoietic recovery and decrease the incidence of severe aGVHD. The accelerated hematopoietic recovery is associated with increased number of CD34+, CFU-GM and CFU-MK in the graft.