改良CVP联合rhG—CSF动员方案外周血干细胞移植治疗血液肿瘤及实体瘤41例

目的：研究改良CVP联合rhG—CSF方案对血液肿瘤和实体瘤41例患者自体外周血干细胞移植（APBSCT）动员及造血重建效果。方法：2001年3月至2006年3月采用改良CVP联合rhG—CSF动员方案，完成APBSCT41例（血液肿瘤32例，实体瘤9例），平均年龄39．6岁（18岁～67岁）。WBC升至4．0×10^9／L左右采集单个核细胞（MNC）并计数MNC和CD34^＋细胞数；预处理结束48h～72h回输MNC。结果：动员期间患者WBC均降至1．0×10^9／L以下，PLT 40×10^9以下。34例1次采集成功，7例（双次移植5例）作第2次采集。采集MNC数0．9×10^8／kg～8．3×10^8／kg（2．8±2．0×10^8／kg），CD34^＋细胞1．1×10^6／kg～9．4×10^6／kg（3．2±2．6×10^6／kg）。预处理后所有病例均达到骨髓抑制，WBC恢复到1．0×10^9／L时间为＋8～＋16d（平均＋11．3d）；38例PLT恢复到50×10^9／L时间为＋13～＋22d（平均＋16．8d），3例P1月恢复延迟，最长＋35d。随访15～65个月，持续完全缓解19例（46．3％），部分缓解或好转13例（31．7％），总有效率78．0％，无效9例（22．0％），无1例发生移植相关死亡（其中5例带瘤生存，17例死亡）。结论：改良CVP联合rhG—CSF动员方案行APBSCT是一种安全有效的动员自体外周血造血干细胞的方法，临床疗效满意。

Study on rhG- CSF combined with improved CVP mobilization regimen in autologous peripheral blood stem cell transplantation in 41 patients with hematological malignancies and solid neoplasms

Objective ：To evaluate the mobilization and hematopoietic reconstitution effects of improved CVP mobilization regimen plus rhG - CSF in 41 autologous peripheral blood stem cells transplantation （APBSCT） patients with hematological malignancies and solid neoplasms. Methods： Forty -one patients aged 39.6 years （range, 18 ~ 67 years） （32 with hematological malignancies and 9 with solid neoplasms） were included from March 2001 to March 2006. The mobilization regimen was improved CVP regimen plus rhG- CSF. Mononuclear cells （MNC） harvest was performed when WBC recovered more than 4.0 × 10^9/L, and the MNC and CD34^＋ cells were counted. MNC was reinfused 48 - 72 hours after preconditioning of high dose chemotherapy. Results： WBC and PLT decreased to 〈 1.0 × 10^9/L （0.1 × 10^9/L- 0.8 × 10^9/L） and 〈 40 × 10^9/L （4 × 10^9/L - 36 × 10^9/L） respectively after mobilizing chemotherapy in all patients. Thirty four patients completed collection with a single apheresis, and 7 patients （5 patients with double APBSCT） underwent twice. The number of MNC and CD34^＋ cells obtained were 0.9 × 10^8/kg - 8.3 × 10^8/kg （2.8 ± 2.0 × 10^8/kg） and 1.1 × 10^6/kg -9.4 × 10^6/kg （3.2 ±2.6 × 10^6/kg）. No severe toxic reactions were observed. After conditioning, WBC recovered to 1.0× 10^9/L at a median time of ＋ 11.3d （ range ＋ 8- ＋ 16d） , and PLT recovered to 50 × 10^9/L at a median time of ＋ 16.8d （range ＋ 13 - ＋ 22d） except 3 patients. With a followup of 5 to 65 months after transplant, 19 patients achieved complete remission （46.3%）, 13 patients partial remission （31.7%） and 9 patients no effects （22.0%）. Conclusion： Improved CVP combined with rhG - CSF was a safe and effective regimen for the mobilization, which can be used in APBSCT with satisfying outcomes.