自体外周血干细胞动员和采集并联合化疗方案治疗儿童神经母细胞瘤及原始神经外胚层肿瘤35例

背景：自体外周血干细胞移植是目前治疗恶性实体瘤的重要方法之一,干细胞动员与采集是决定造血重建的重要因素。目的：主要评价环磷酰胺,吡柔比星,长春新碱动员方案对儿童神经母细胞瘤及原始神经外胚层肿瘤自体外周血造血干细胞移植动员采集的临床效果。方法：对35例患儿,确诊神经母细胞瘤30例,原始神经外胚层肿瘤5例,采用CDV化疗方案动员,观察采集干细胞效果。结果与结论：所有病例化疗后第4～9天（平均6.5d）白细胞〈2×109L-1,给予粒细胞刺激因子5～10mg/kg刺激造血,化疗后13～19d（平均15.5d）至白细胞〉5×109L-1后开始采集。所有病例均采集到足够的单个核细胞数和CD34＋细胞,总采集次数1～4次,平均2.1次,单个核细胞：（6.1±1.2）×108/kg,CD34＋细胞为（5.3±0.8）×106,锥虫蓝拒染率：99.5%（99%～100%）,动员并发症少,患儿均能耐受。其中25例进行自体外周血干细胞移植后均获快速造血功能重建,白细胞开始回升（中性粒细胞绝对值〉0.5×109L-1）时间为移植后10～20d（平均14d）血红蛋白恢复（〉80g/L）的时间为移植后10～30d（平均18d）,血小板恢复（〉20×109L-1）时间为移植后12～35d（平均20d）。结果提示CDV方案可以安全有效地完成神经母细胞瘤及原始神经外胚层肿瘤患儿自体外周血干细胞动员和采集。

Mobilization and collection of autologous peripheral blood stem cells combined with chemotherapy regimen for treatment of neuroblastom/primitive neuroectodermal tumor in 35 children

BACKGROUND：Autologous peripheral blood stem-cell transplantation（APBSCT） is an important method to treat malignant solid tumor in children.Mobilization and collection of stem cells are the key for hematopoietic reconstitution.OBJECTIVE：To evaluate the clinical effect of mobilization and collection by cyclophosphamide,doxorubicin and vincristine mobilization chemotherapy program in children with neuroblastom/primitive neuroectodermal tumor（NB/PNET）.METHODS：Protocol of cyclophosphamide,doxorubicin and vincristine mobilization was used as mobilization chemotherapy in 35 cases（including 30 NB and 5 PNET）.Effect of stem cell collection was observed.RESULTS AND CONCLUSION：Leukocytes decreased to less than 2×109/L on 4-9 days（averagely 6.5 days） after the chemotherapy when granulocyte-colony stimulating factor（G-CSF） 5-10 mg/kg was given to stimulate hematopoiesis.Collection began when leukocytes reached to more than 5×109/L on 13-19 days after chemotherapy（averagely 15.5 days）.Mononuclear cells and CD34＋ cells were successfully collected in all cases.Total collection times were 1-4 times,averagely 2.1 times.The volumes of mononuclear cells and CD34＋ cells were respectively（6.1±1.2）×108/kg and（5.3±0.8）×106/kg.Trypan blue exclusion rate was 99.5%（99%-100%）.No severe complication was observed during the mobilization.All subjects could tolerate.Prompt and sustained hemocytoblastic reconstitution was observed in 25 children.Leukocytes began to increase（neutrophilic granulocytes 0.5×109/L） at 10-20 days posttransplantation（averagely 14 days）.Hemoglobin recovered（ 80 g/L） at 10-30 days posttransplantation（averagely 18 days）.Platelet recovered（ 20×109/L） at 12-35 days posttransplantation（averagely 20 days）.The program of cyclophosphamide,doxorubicin and vincristine is a highly efficient autologous peripheral blood stem cell mobilization and collection protocol in children with NB/PNET.