阿糖胞苷联合粒细胞集落刺激因子动员自体外周血干细胞效果的研究

目的　观察阿糖胞苷 (Ara C)联合重组人粒细胞集落刺激因子 (rhG CSF)对恶性淋巴瘤患者自体外周血造血干细胞 (APBSC)的动员效果 ,并寻找Ara C合适的给药剂量。方法　按照入组的先后顺序 ,将患者分成两组 ,A组Ara C的给药剂量为 6g/m2 静滴 (分 2次 ,间隔 2 4h) ,B组Ara C的给药剂量为 10g/m2 静滴 (分 4次 ,间隔 12h) ,白细胞 (WBC)降至最低点时开始皮下注射rhG CSF 30 0 μg·人 -1·d-1,直至采集结束前 1d ,白细胞恢复到 5 .0× 10 9/L以上时开始连日采集APBSC ,当累计采集的单个核细胞≥ 5× 10 8/kg或CD34+ 细胞≥ 2× 10 6/kg时停止采集。结果　 2 2例患者进入本研究 ,A、B两组各有 11例患者。Ara C给药后 ,患者外周血中白细胞和中性粒细胞绝对值 (ANC)的最低值 ,B组明显低于A组 ,出现的时间B组也明显晚于A组。A、B两组rhG CSF给药的开始时间和持续时间、APBSC采集的开始时间和持续时间均无显著差异 ,在APBSC采集时的循环血量、血流速和采集时间相同的情况下 ,APBSC的采集次数、每次采集的细胞数量和总量亦差异无显著意义 ,B组Ara C引起的某些毒副反应略重于A组 ,但两组间差异无显著意义。结论　Ara C联合rhG CSF是一种安全、高效的APBSC的动员方法 ,6g/m2 的Ara C即可得到满意的动员效果。

Mobilization of autologous peripheral blood stem cells by cytosine arabinoside combined with recombinant human granulocyte colony-stimulating factor

OBJECTIVE: To observe the effect of cytosine arabinoside (Ara-C) combined with recombinant human granulocyte colony-stimulating factor (rhG-CSF) on mobilization of autologous peripheral blood stem cells (APBSCs) among malignant lymphoma patients and investigate appropriate dose of Ara-C. METHODS: Twenty-two patients with malignant lymphoma were randomly divided into two groups: in group A 3 g/m2.d-1of Ara-C was administered by intravenous drip in 2 divided doses for two days with the total dose of 6 g/m(2); in group B 5 g/m(2).d(-1) of Ara-C was administered by intravenous drip in two divided doses for two days with the total dose of 10 g/m(2). Blood routine examination was made every day. rhG-SCF at the dose of 300 microg.body(-1).d(-1) was injected subcutaneously once a day since the next day when the white blood cells reached the nadir until the end of APBCS harvest. APBSC harvest began when WBC >/= 5.0 x 10(9)/L and finished when the accumulated mononuclear cells >/= 5 x 10(5)/kg. RESULTS: The median of days when nadir of WBC appeared was 7 days in group A and 10 days in group B. The median of absolute neutrophil count (ANC) at ite nadir was 0.9X109/L in group A and 0.2 x 10(9)/L in group B. The median of days when ANC reached its nadir was 9 days in group A and 13 days in group B. The median of dose of rhG-CSF was 4.35 microg.kg(-1).d(-1) in group A and 4.35 microg.kg(-1).d(-1) in group B. The median of day when rhG-SCF administration began was the 11th day in group A and the 12th day in group B. The median of rhG-SCF administration days was 5 days in group A and 6 days in group B. The median of day when APBSC harvest began was the 15th day after Ara-C administration in group A and the 16th day in group B. The median of harvest time was 2 days in both groups. The volume, speed, and time of each apheresis were similar in the two groups. The time consumed and number of APBSCs collected in each harvest and the total number of APBSCs collected were similar in these two groups. CONCLUSION: Ara-C combined with rhG-CSF is safe and highly effective for APBSC mobilization. 6 g/m(2) is the suitable dose for APBSC mobilization.