摘要
目的探讨单次大剂量足叶乙甙（Vpl6）静脉注射联合粒细胞集落刺激因子（G·CSF）用于恶性血液病患者自体外周血造血干细胞（APBSC）动员的有效性和安全性。方法80例恶性血液病患者包括急性白血病（AL）20例、多发性骨髓瘤（MM）23例、非霍奇金淋巴瘤（NHL）35例、霍奇金淋巴瘤（HL）2例，均采用Vpl61．6g／m。匀速持续静脉注射10h，外周血中性粒细胞计数（ANC）降至1×109／L时开始给予G—CSF10μg·kg-1·d-1皮下注射，至采集结束。WBC〉5．0X109／L时开始APBSC采集，目标值：单个核细胞（MNC）／〉6．0×10。／kg且CD34’细胞〉／2．0×106／kg。患者经预处理后回输自体外周血干细胞。观察动员采集过程中血液学指标变化、采集细胞数量、造血重建时间、不良反应等。结果足叶乙甙应用后11（7—25）d开始干细胞采集，中位采集次数为2（1—5）次。80例患者中，APBSC动员失败3例，均为急性非淋巴细胞白血病（ANLL）患者；既往其他方案动员自体干细胞失败的6例患者中5例动员成功，1例既往阿糖胞苷动员失败的ANLL—M，患者足叶乙甙动员仍失败；77例患者CD34＋细胞中位数为4（1．59—24．68）×10。／kg，其中3例患者CD34＋细胞未达2×106／kg，但移植后造血顺利重建。对20例AL和23例MM患者采集物行微量残留病检测，未发现采集物残留肿瘤细胞污染。所有患者均良好耐受动员、采集过程。80例患者在干细胞动员过程中，Ⅳ度白细胞减少发生率为36．25％（29／80），感染发生率为23．75％（19／80）。结论单次大剂量足叶乙甙联合G—CSF动员APBSC总体成功率高，不良反应可控，是恶性血液病患者动员采集APBSC安全有效的方案。
Objective To explore the effectivity and safety of single high-dose （HD） etoposide （Vpl6） with granulocyte colony-stimulating factor （G-CSF） for mobilization of autologous peripheral blood stem ceils（PBSC） in patients with hematologic malignancies. Methods 80 patients of hematologic malig- nancies including 20 patients with acute leukemia （ AL）, 23 with multiple myeloma （ MM ）, 35 with non- Hodgkin＇ s lymphoma（NHL） and 2 with Hodgkin＇ s lymphoma（HL） received Vpl6（ 1.6 g/mz） continuous intravenous infusion for 10 hrs on day 1. G-CSF at 10 ~g/kg once daily subcutaneous injection began to use on day of ANC lower than 1 ~ 109/L and continued until PBSC collection was completed. Autologous PBSC （APBSC） was collected on day of WBC greater than 5 ~ 109/L and continuing until the collection goal was met（target value： MNC ~〉6.0 ~ 108/kg and CD34 ＋ t〉2.0 x 106/kg）. The patients received APBSC after conditioning regimen. The number of the cells collection, time of hemotopoietic reconstruction, adverse effect and so on were observed during the course of stem cell mobilization and collection. Results PBSC was col- lected on day 11 （range： 7 -25 days） of after Vpl6 administration with a median collection time of 2（range 1 - 5 ）. 3/80 patients with AML got stem cell mobilization failure. 5 of 6 patients who failed to mobilize before got successful stem cell mobilization, 1/6 patient with AML-M5 got a second failure after the mobilization of VP16 whose first time＇ s mobilization using Ara-C did not succeed. The median number of CD34 ＋ cells collected in 77 patients who got successful mobilization was 4 x 106/kg [ range（ 1.59 -24.68 ） x 106/kg]. The collection of 20 patients with AL and 23 with MM were got detection for minimal residual ~ tisease, no pollution of tumor cells were happened. All patients could tolerate the whole course of stem cell mobilization. 29/80 （36.25%） patients got a 4 grade leucopenia, 19/80 （23.75%） patients got infection. Conclusion Single high-dose etoposide with G-CSF for mobiliZation of APBSC has a higher achievement rati- o, a controllable adverse effect, a promising hematopoiesis recovery, which is an effective and safe mobilizing regimen for patients with hematologic malignancies.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2012年第8期628-631,共4页
Chinese Journal of Hematology
关键词
足叶乙甙
动员
外周血造血干细胞
Etoposide
Mobilization
Peripheral blood hematopoietic stem cell
