异基因造血干细胞移植CD34^＋CD61^＋巨核系前体细胞与血小板植入的相关分析

本研究通过定量测定G—CSF动员后外周血及骨髓采集物的CD34^＋CD61^＋细胞，以探索巨核前体细胞CD34^＋CD61^＋亚群输注量与异基因外周血和／或骨髓移植后血小板恢复时间的相关性。24例不同血液病患者接受HLA全相合同胞、非血缘供者或单倍体相合同胞造血干细胞移植。20例可评估的患者依移植方法不同分为HLA全相合组和单倍体相合组，HLA全相合组采用PBSC移植方案，单倍体相合组采用PBSC＋BM联合移植方案，对外周血干细胞和骨髓样本CD34^＋CD61^＋亚群通过流式细胞仪立即测定或隔夜保存后测定。结果表明，单倍体相合组输注CD34^＋、CD34^＋CD61^、CD34^-CD61^＋细胞数中位值分别为6．24×10^6／kg（1．53—20．48）、66．19×10^4／k（8．16—493．83）、34．38×10^6／kg（14．71—109．16）；HLA全相合组中位值分别为4．88×10^6／kg（1．00—8．24）、14．16×10^4／kg（11．63—96．87）和13．50×10^6／kg（1．74—35．61）。中性粒细胞计数（ANC）〉0．5×10^9／L和血小板计数〉20×10^9／L的中位时间，单倍体相合组分别为18．5（11．00—29．00）和16．5（9．00—35．00）天；HLA全相合组为14．5（9．00—24．00）和10．5（6．00—37．00）天，血小板的植入时间在两组差别无显著性，中性粒细胞植入时间在HLA全相合组和单倍体相合组差异有显著性（p=0．048），对于两组中CD34^＋细胞量〉2×10^6／kg的受者血小板的植入时间分析，两组差别有显著性（p=0．006）。CD34^＋CD61^＋亚群与血小板植入的相关性明显优越于CD34^＋细胞，可评估20例（r=-0．449p=0．047CD34^＋细胞群），单倍体相合组12例CD34^＋CD61^＋亚群（r=-0．768p=0．004），HLA相同纽8例CD34^＋CD61^＋亚群（r=-0．747p=0．033），CD34^＋CD61^＋亚群与血小板的植入时间呈负相关关系，输注CD34^＋CD61^＋亚群细胞量大，血小板的植入时间缩短。结论

Correlation between CD34+CD61+ Megakaryocyte Precursors and Platelet Engrafment in Allogeneic Hematopoietic Stem Cell Transplantation

This study was purposed to investigate the correlation between the dose infused megakaryocytic precursors （ CD34^＋ , CD34^＋CD61^＋ ） and recovery time of platelet count following an allogeneic PBSCT and/or BMT through quantitative detection of CD34^＋ and its subpopulation in peripheral blood and BM mobilized by G-CSF. 24 patients with various hematologic malignancies recieved PBSCT/BMT from their HLA matched or unrelated donors and haploidentical siblings in April - December 2007. 20 evaluated patients were divided into 2 groups according to different tansplant schemes. HLA matched group received PBSCT regime and haploidentical group recieved PBSCT combined with BMT. CD34^＋ CD61 ^＋ subpopulations in sample from patients recieving PBSCT/BMT were measured by flow cytometry immediately or storage over night. The results showed that the median number of infused CD34 ^＋ , CD34^＋CD61^＋ and CD3^ - CD61^＋ cells in haploidentical group were 6.24 × 10^6/kg （ 1.53 - 20.48 ）, 66.19 × 10^4/kg （ 8.16 - 493.83 ）, and 34.38 × 10^6/kg （ 14.71 - 109.16） respectively, in HLA matched group those were 4.88 × 10^6/kg （ 1.00 - 8.24）, 14. 16 × 10^4/kg （ 11. 63 - 96.87）, and 13.50 × 10^6/kg （ 1.74 - 35.61 ）, respectively. Median days of ANCs 〉 0.5 × 10^9/L and platelets 〉 20 × 10^9/L were 18.5 （ 11.0 - 29.0 ） days and 16.5 （9.0 - 35.0 ） days in haploidentical grouprespectively; in HLA matched group those were 14.5 （9.0 - 24.0） and 10.5 （6.0 -37.0） respectively. A significance difference of median days for ANC engrafment presented between two groups （p = 0. 048 ）. There was no signifciant difference of time for platelet engrafment between 2 groups. For patients with CD34 ^＋ cell dose 〉 2 × 10^6/kg there was singnificant difference of time of platelet engrafment between HLA matched and haploidentical groups （p = 0.006）. The number of CD34^＋ CD61^ ＋ ceils infused in 12 haploidentical patients or in 8 HLA matched patients were much better correlated w