小剂量G-CSF联合GM-CSF动员外周血CD34+细胞

目的 探讨小剂量粒单巨噬细胞集落刺激因子(GM-CSF)联合粒细胞集落刺激因子(G-CSF)动员外周血干细胞的效率。方法 20例成人恶性血液病按统计学配对方法等分为2组。非霍奇金氏淋巴瘤(NHL)患者化疗方案为环磷酰胺2.0 g/d,静脉滴注,第1~2天,足叶乙甙0.2 g/d,静脉滴注,第1~3天;急性非淋巴细胞白血病(ANLL)患者用阿糖胞苷2.0 g/d,静脉滴注,第1~3天,足叶乙甙用法同NHL。当白细胞低于1.0×10⁹/L时研究组10例应用GM-CSF 2.5 μg/d·kg·b.w.联合G-CSF 2.5 μg/d·kg·b.w.;对照组单用G-CSF 5 μg/d·kg·b.w.,全部皮下注射5~6 d。白细胞5.0×10⁹/L以上时应用CS-3000 pluse分离外周血单个核细胞,流式细胞术计数CD34⁺细胞。结果 产品细胞分类计数单个核细胞占95%~99%,在研究组CD34⁺细胞平均采集9.4(8.4~10.2)×10⁶/kg·b.w.,CFU-GM 42.4(21.9~72.8)×10⁴/kg·b.w.,对照组平均采集CD34⁺细胞4.8(4.1~8.3)×10⁶/kg·b.w.,CFU-GM 28.1(7.1~60.2)×10⁴/kg·b.w.,2组差异显著(P<0.05)。副作用2组相似。结论 恶性血液病患者化疗后应用G-CSF联合GM-CSF动员CD34⁺细胞的效果优于单用G-CSF。

Low-dose granulocyte colony-stimulating factor combined with granulocyte-macrophage colony-stimulating factor for mobilizing peripheral CD34+ hematopoietic progenitor cells

Objective To study the efficacy of combined use of low-dose granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in mobilizing hematopoietic stem/progenitor cells. Methods Twenty adult patients with malignant hematologic diseases were paired using statistical methods, and the 10 pairs were divided into 2 equal groups. For non-Hodgkin lymphoma, the treatment regimen adopted intravenous infusion of cytoxan (2 g/d for 1 or 2 d) and VP16 (0.2 g/d for 1 to 3 d), while for acute non-lymphocytic leukemia, Ara-C (2 g/d for 1 to 3 d) and VP16 (0.2 g/d for 1 to3 d) were used. When the while blood cell count (WBC) was below 1.0×10⁹/L, G-CSF and GM-CSF were administered subcutaneously at the same dose of 2.5 μg/d·kg in the 10 patients in the experimental group, while the patients in the control group received only 5 μg/d·kg G-CSF, both for 5 to 6 d. After WBC>5.0×10⁹/L, the peripheral blood mononuclear cells (PBMNC) were separated by CS-3000 pluse separator and CD34⁺ cells were determined by flow cytometry. Results The purity of the isolated PBMNC was 95%-99%. In the experimental group, the mean number of CD34⁺ cells acquired was 9.4×10⁶/kg ranging from 8.4×10⁶ to 10.2×10⁶/kg, and granulocyte-macrophage colony-forming unit (CFU-GM) was 42.4×10⁴/kg on average ranging from 21.9×10⁴ to 72.8×10⁴/kg, as compared with 4.8×10⁶/kg(4.1-8.3) ×10⁶/kg]for CD34⁺ cells and 28.1×10⁴/kg(7.1-60.2)×10⁴/kg]for CFU-GM in the control group (P<0.05). No obvious difference was observed between the two groups in terms of the adverse effects of the treatment (P>0.05). Conclusion Combined use of G-CSF and GM-CSF can be more effective than the exclusive use of GM-CSF for mobilizing CD34⁺ cells.