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目的:探讨COAEP化疗方案联合粒细胞集落刺激因子(G-CSF)治疗对血液病患者外周血干细胞(PBSC)动员的效果。方法:选择恶性血液病患者24例,其中非霍奇金淋巴瘤(NHL)15例,多发性骨髓瘤(MM)6例,霍奇金病(HD)3例。以COAEP方案动员[d1(第1天):环磷酰胺(CTX)400 mg/m~2,长春地辛(VDS)2 mg/m~2;d1～5应用阿糖胞苷(Ara-C)60 mg/m~2,依托泊甙(VP-16)60 mg/m~2,泼尼松(Pred)30 mg/m~2]。将患者随机分为试验组和对照组。试验组取患者化疗后自细胞抑制达最低点开始稳定回升(第二次回升)时为节点,予G-CSF(惠尔血)300μg/d;而对照组以动员方案结束后白细胞跌至低谷首次回升时即使用G-CSF 300μg/d。2组患者开始使用G-CSF后每日查血常规,当白细胞计数>10.0×10~9/L和单个核细胞(MNC)计数>1.0×10~9/L时使用COBE血细胞分离机,以自动单个核细胞分离程序采集PBSC。结果:使用COAEP方案动员后,24例恶性血液病患者平均获得的CD34+细胞数达每例17.25×10~6/kg。试验组患者平均使用G-CSF的时间为4.17 d,采集PBSC次数为1～2次,采集液CD34+细胞数为每例11.73×10~6/kg(几何均值);对照组患者平均使用G-CSF的时间为5.92 d,采集PBSC次数为1～2次,采集液CD34+细胞数为每例1.79×10~6/kg(几何均值),2组间差异有统计学意义(P<0.0028)。结论:COAEP联合化疗可作为血液病患者自体PBSC动员的方案,并能获得良好的干细胞产率。患者白细胞开始稳定回升时使用G-CSF,可显著提高PBSC产率。根据患者外周血白细胞计数及单个核细胞数决定PBSC采集时机有效可行,值得临床推广。
Objective: To investigate the effect of COAEP chemotherapy combined with granulocyte-colony stimulating factor (G-CSF) on mobilization of peripheral blood stem cells (PBSC) in patients with hematological diseases. Methods: Twenty-four patients with hematologic malignancies were selected. Among them, 15 were non-Hodgkin lymphoma (NHL), 6 were multiple myeloma (MM) and 3 were Hodgkin’s disease (HD). Patients were challenged with COAEP regimen (d1, day 1): Cyclophosphamide (CTX) 400 mg / m 2, VDS 2 mg / m 2; ) 60 mg / m ~ 2, Etoposide (VP-16) 60 mg / m ~ 2, Pred 30 mg / m ~ 2]. The patients were randomly divided into experimental group and control group. In the experimental group, the cells were treated with G-CSF (300μg / d) for the first time since the cell cycle began to stably rebound (the second rebound) after chemotherapy. In the control group, the leukocytes fell to the bottom after mobilization G-CSF 300 μg / d was used for the first rebound. Two groups of patients started daily routine blood tests after using G-CSF. When white blood cell count> 10.0 × 10-9 / L and mononuclear cell (MNC) count> 1.0 × 10-9 / L, COBE blood cell separator Automated mononuclear cell isolation procedure collects PBSC. Results: After the COAEP regimen was mobilized, the average number of CD34 + cells in 24 patients with hematologic malignancies was 17.25 × 10 ~ 6 / kg per case. In the experimental group, the average time of using G-CSF was 4.17 days, the number of PBSC was 1 to 2 times, and the number of CD34 + cells in each group was 11.73 × 10 ~ 6 / kg (geometric mean). In the control group, G- CSF was 5.92 days, the number of PBSC was 1 ~ 2 times and the number of CD34 + cells in each sample was 1.79 × 10 ~ 6 / kg (geometric mean). There was significant difference between the two groups (P <0.0028). CONCLUSIONS: COAEP combined with chemotherapy can be used as a regimen of autologous PBSC mobilization in patients with hematologic disorders and achieve good stem cell yield. The use of G-CSF in patients with a stable rise of leukocytes markedly improved PBSC yield. According to the patient’s peripheral blood leukocyte count and mononuclear cells determine the timing of PBSC collection is feasible and effective, worthy of clinical promotion.