重组人G-CSF对健康供者外周造血干／祖细胞动员和采集效果的影响因素分析

应用重组人粒系集落刺激因子（rhG—CSF）对健康供者进行动员并采集造血干细胞用于异基因外周血造血干细胞移植已在临床广泛应用，本研究通过对影响外周干细胞动员和采集效果的多因素分析，进一步探讨最佳动员方案及采集时机。采取回顾性方法分析了431例健康供者外周血干细胞动员采集效果，并进一步分析了供者一般特征、rhG—CSF动员天数、每日皮下注射次数、剂量与采集效果的关系。结果表明：rhG—CSF在动员中平均应用剂量为5．7μg／（kg·d），平均采集1．7次，收获单个核细胞数平均为9．57×10^8／kg，CD34^＋细胞平均为4．91×10^6／kg。绝大多数供者不良反应轻微。多因素分析结果显示，采集效率主要与供者体重指数，采集天数相关。rhG—CSF动员第5天采集的供者，其MNC数、CD34^＋细胞数及第一次单采成功率均优于其他时间采集的供者。同时，本组供者应用rhG—CSF剂量较小且剂量范围较窄，rhG—CSF剂量不如采集时间对采集物质量的影响明显。结论：小剂量应用rhG—CSF动员并于第5天开始采集是健康供者造血干细胞动员的较理想方案。

Factors Affecting Mobilization of Peripheral Blood Stem/Progenitor Cells and Apheresis Efficiency from Healthy Donors by rhG-CSF

This study was aimed to explore the factors impacting on effect of the recombinant human granulocyte colony-stimulating factor (rhG-CSF) in mobilizing and collecting peripheral blood stem/progenitor cells (PBSPC) from healthy donors, and to determine the optimal time for PBSPC harvest. A mobilization course in 431 healthy donors was retrospectively studied and the factors influencing the efficacy of mobilization were analyzed. The normal donors underwent leukapheresis for PBSPC collection in multicentres after mobilization with G-CSF administered. A variety of items analyzed included donor age, sex, weight, body mass index (BMI), daily G-CSF dose and schedule of G-CSF administration. The results showed that G-CSF was administered subcutaneously at median 5.7 microg/kg for mobilization for 3 - 5 days, The median number of peripheral blood mononuclear cells (PBMNC) count of per kg recipient weight was 9.57 x 10(8) and CD34(+) cells per kg recipient weight was 4.91 x 10(6) after a median of 1.7 leukapheresis. The side effects were mild and well tolerated. By univariate analysis, BMI, daily G-CSF dose and schedule of administration were significantly correlated with the yield of PBMNCs, CD34(+) cells. The best apheresis yields of PBMNCs and CD34(+) cells were achieved on day 5 after treatment with rhG-CSF. Because the narrow range and low dose of rhG-CSF administration, there were minor effects of rhG-CSF dose compared with schedule of administration. It is concluded that mobilization and leukapheresis are safe in healthy donors and that the low dose of rhG-CSF in 5-day administration are probably optimal for donor management.