化疗加G-CSF和GM-CSF联合动员自体外周血干细胞

目的　探讨化疗加粒细胞集落刺激因子 (G CSF)和粒 巨噬细胞集落刺激因子 (GM CSF)联合动员自体外周血干细胞 (APBSC)的效果。方法　卡铂 (CBP) 35 0mg m2 ,第 1天静滴 ;足叶乙甙(Vp16 ) 35 0mg m2 ,第 1～第 3天静滴 ;白细胞降至最低点又回升到 (2 .4～ 6 .4)× 10 9 L时 ,皮下注射G CSF 5 μg·kg- 1 ·d- 1 (早 6∶0 0 ) GM CSF 5 μg·kg- 1 ·d- 1 (晚 6∶0 0 ) 地塞米松 5mg d(采集日 10mg d)直到采集结束前 1天 ;白细胞上升到 (2 9.80± 5 .98)× 10 9 L ,开始用CS30 0 0plus血细胞分离机连续 2d采集APBSC。结果　 2 0例患者连续采集APBSC 2次 ,共采集到MNC(5 .93± 1.6 2 )× 10 8 kg ,CD34 细胞 (2 3.10± 11.5 3)× 10 6 kg ,CFU GM(3.44± 2 .85 )× 10 5 kg。无严重不良反应。 9例 10次自体外周血干细胞移植(APBSCT)造血功能均获满意重建。结论　以化疗联合G CSF和GM CSF能高效、安全地动员APBSC ,1次动员采集 2次可满足 1～ 2次的APBSCT。     

乳腺癌患者大剂量环磷酰胺化疗方案联合G—CSF动员外周血造血干细胞

评价大剂量环磷酰胺化疗方案联合G-CSF对乳腺癌患者外周血造血干细胞的动员效果.动员方案为在常规联合化疗方案的基础上,提高环磷酰胺剂量2-4倍,化疗后当外周血WBC降至1.0×10 9/L以下时给予G-CSF,150微克/次,2次/日.在WBC恢复升高至5.0×10 9/L以上时,进行外周血造血干细胞采集.结果共有10例乳癌患者完成了上述方案的外周血造血干细胞动员,WBC降低的中位最低值为0.8(0.4-1.0)×10 9/L,造血干细胞的中位采集次数为2(2-3)次;采集的CD34+细胞中位数为6.43(1.99-18.75)×10 6/kg.结论提示,大剂量环磷酰胺化疗方案联合G-CSF是乳癌患者理想的外周血造血干细胞动员方案.     

大剂量足叶乙甙和G-CSF用于恶性血液病外周血造血干/祖细胞动员

为了观察大剂量足叶乙甙(VP16)和粒细胞集落刺激因子(G-CSF)在恶性血液病人动员采集自体外周血造血干/祖细胞的有效性和安全性,对10例恶性血液病患者(多发性骨髓瘤6例,非霍奇金淋巴瘤4例),第1天用足叶乙甙1.6g/m2静脉持续滴注10小时,第3天起给予G-CSF5μg/kg,每日1次,皮下注射,直至采集结束。结果显示:用VP16后平均第11(9-13)天开始外周血造血干/祖细胞单采,获CD34+细胞9.4×106/kg(4.2-17.3×106/kg),每例CD34+细胞>4.0×106/kg。平均采集次数2.6(1-4)次。1例发生口咽黏膜炎、2例尿道炎、咽喉炎。结论:足叶乙甙1.6g/m2和G-CSF5μg/kg是恶性血液病动员采集自体干祖细胞的有效安全方案。     

中剂量环磷酰胺联合化疗加粒细胞集落刺激因子对恶性血液病患者自体外周血干细胞的影响

目的探讨以中剂量环磷酰胺为主联合化疗加单一剂量重组人粒细胞集落刺激因子(GCSF)对恶性血液病患者自体外周血造血干细胞的动员效果。方法31例患者接受中剂量环磷酰胺2.2g/m2(1.8~3.0g/m2)联合鬼臼乙叉甙(Vp16)600~800mg(CE方案)或阿糖胞苷(AraC)1.0~2.0g/m2(CA方案)化疗。预处理后,予以回输所采自体外周血造血干细胞,观察造血重建情况。结果动员所需时间(化疗开始至采集的平均时间)为(13.5±2.0)d,采集次数为(2.9±1.0)次,WBC最低值为(0.95±1.0)×109/L,GCSF开始给药时间为第(8.6±2.0)天,持续应用平均(7.4±2.0)d,采集到的单个核细胞数为(5.53±2.54)×108/L,CD34+细胞数为(9.46±7.24)×106/L,粒单核细胞集落数为(46.02±70.58)×104/L。全部移植患者造血功能均获满意重建。结论中剂量环磷酰胺为主联合化疗(CE/CA)加单一剂量GCSF对恶性血液病患者的造血干细胞动员是安全和有效的。     

G-CSF对体内树突状细胞亚群的调节作用

目的 :研究G CSF体内应用对小鼠外周血树突状细胞 (DC)亚群的调节作用。方法 :四组BALB/c小鼠分别给予 0、5、10、15 μgrhG CSF皮下注射 ,1次 /d ,连续 6d。第 6天用密度梯度离心法结合补体结合细胞毒性单克隆抗体法阴性选择分离得到外周血DC ,用流式细胞仪检测DC1(CD11c+ CD8a-)和DC2 (CD11c+ CD8a+ )的比例 ,并计算其绝对值。结果 :经不同剂量的G CSF刺激后 ,小鼠外周血DC1的绝对值无显著变化 ,而DC2的绝对值明显增加 (9 6× 10 6/Lvs 5 5 1× 10 6/L ,P <0 0 1) ,DC1/DC2的比值显著降低 (4 2vs 0 7,P <0 0 1)。结论 :G CSF可调节外周血DC1和DC2亚群的数量和比例 ,应该在抗原提呈水平重新评估G CSF的临床应用     

MAG方案对恶性血液病患者造血干细胞动员作用的研究

目的　研究米托蒽醌 (MTZ)联合大剂量阿糖胞苷 (Ara C)、重组人粒细胞集落刺激因子(rhG CSF)组成MAG方案对恶性血液病患者外周血干细胞的动员作用。方法　 1995年 12月至2 0 0 3年 4月 ,采用MAG方案对 14例恶性淋巴瘤和 2 9例急性白血病患者外周血干细胞进行动员 ,其用量为MTZ 10mg/m2 ,第 2 ,3天 ;Ara C 2 g/m2 ,每 12h 1次 ,第 1,2天 ;rhG CSF 30 0 μg/d。首先用MA方案联合化疗 ,白细胞 <1.0× 10 9/L时开始用rhG CSF ,白细胞回升时用CS 30 0 0plus或CobeSpectra血细胞分离机采集外周血干细胞。结果　 14例恶性淋巴瘤患者除 1例外周血干细胞采集失败外 ,其余 13例均 1次性采集成功 ,所得单个核细胞 (MNC) (3.91± 2 .70 )× 10 8/kg ,CD34 细胞 (17.79± 12 .90 )× 10 6/kg。采集 2 9例急性白血病患者外周血干细胞平均 2 .13次 ,2 4例采集成功 ,5例采集失败 ,所得MNC (3.6 2± 2 .89)× 10 8/kg ,CD34 细胞 (7.37± 6 .6 0 )× 10 6/kg。rhG CSF平均使用时间为 7d。经MAG方案动员后 ,除 8例患者有胃肠道反应、14例患者骨髓抑制期合并感染外无明显不良反应 ,无动员相关死亡。MAG方案动员后进行微小残留病检测 ,部分病例转为阴性。结论　MAG方案在恶性淋巴瘤和急性白血病患者外周血干细胞动员中安全     

自体外周血干细胞移植联合单倍体淋巴细胞输注治疗恶性血液病

为观察自体外周血干细胞移植联合单倍体淋巴细胞输注治疗恶性血液病的疗效和不良反应 ,对完全缓解或部分缓解的恶性血液病患者用中剂量阿糖胞苷 (1.g/m2 × 5天 )或环磷酰胺 (6 0mg/kg× 2天 )联合G CSF方案动员干细胞 ,并经程序降温仪冷冻 ,- 196℃保存。用Bu/Cy或TBI/Cy方案对患者预处理后 ,回输未净化的自体干细胞。当患者白细胞恢复至 1.0× 10 9/L时 ,输注经 7.5Gy照射的单倍体淋巴细胞 (平均 5 .0× 10 7/kg) ,观察患者造血恢复、疾病转归和长期生存率。结果表明 ,12例接受该方案治疗的患者中 ,5例急性非淋巴细胞白血病患者呈持续缓解状态 ,其中 2例无病生存超过 5 0个月 ;3例IV期恶性淋巴瘤患者中 1例长期缓解 ,2例分别于治疗后 4和 6个月复发而死亡 ;1例淋巴瘤 白血病患者持续缓解 18个月 ,2例慢性粒细胞白血病患者也呈持续缓解状态 ,1例多发性骨髓瘤患者持续缓解 36个月后复发 ,但经反应停治疗目前仍处完全缓解状态。平均随访 2 5个月 ,10例无病生存 ,2年无病生存率 83%。单倍体淋巴细胞输注后在部分患者中除血小板恢复延迟外 ,未见严重不良反应。STR PCR示单倍体淋巴细胞输注后 72小时供者淋巴细胞在受者体内消失。结论 :自体干细胞移植联合单倍体淋巴细胞输注可减少急性白血病的复发 ,提高自     

在淋巴瘤、骨髓瘤和实体瘤中大剂量环磷酰胺动员后影响周血干细胞收集的因素

本文作者研究的目的是确定在不同恶性肿瘤中,大剂量环磷酰胺(Cy)动员后,对能收集到合适数量的周血造血祖细胞的影响因素。自1988年2月至1991年12月,60例病人进行了这个研究,其中淋巴瘤27例,多发性骨髓瘤(MM)6例,乳腺癌17例,其他晚期恶性实体瘤10例。动员前既往治疗者,淋巴瘤121例,MM5例,实体瘤10例。动员剂为单剂量Cy(4或7g/m~2)2小时输注,当周血中中性粒细胞绝对数(ANC)超过0.8×10~9/L 时采集周血干细胞。每例病人每疗程进行4～     

阿糖胞苷、鬼臼乙叉甙联合粒细胞集落刺激因子动员自体外周血干细胞

目的:探讨Ara—C、VP16单用或联合用药加G—CSF动员自身外周血干细胞（APBSC）的效果。方法:5例每天单用Ara-C4g/m2,连用2d;2例每天单用VP—16 500mg/m2,连用4d;2例Ara-C与VP-16联合用药,每天剂量Ara-C1g/m2、Vp-16100mp/m2,连用5d。WBC降至10×109/L左右时加用惠尔血5μg·kg-1·d-1至采集结束。CD34+细胞/MNC>1％时用CS3000 plus血细胞分离机采集APBSC。结果:CD34+细胞/MNC持续超过1％的平均时间为≥5.1d,9例单次采集即获得CD34+26.6×106/kg,无严重不良反应。结论:Ara—C、VP16单用或联合用药加粒细胞集落刺激因子动员自身外周血干细胞的动员效率高,且安全,单次采集所获得造血干细胞的量可满足移植所需。     

单倍体相合骨髓移植白血病患者造血重建的临床研究

为研究未去除T细胞的单倍体骨髓移植后造血重建的特点 ,对 15例HLA 2 - 3个位点不匹配骨髓移植亲属供者使用G CSF 3- 4 μg/ (kg·d) ,连续 7天后采髓。预处理方案采用大剂量阿糖胞苷联合环磷酰胺和全身照射。应用环孢菌素A和氨甲喋呤、抗胸腺细胞球蛋白及霉酚酸酯 (MMF)预防移植物抗宿主病。移植后观察血像、骨髓像、行染色体分析及HLA位点鉴定。移植后分别于 3,6和 12个月及 2年追踪鉴定植入状态。结果发现 ,15例患者全部移植物植入 ,移植后中性粒细胞 >0 .5× 10 9/L和血小板 >2 0× 10 9/L的时间分别为 18(13- 2 3)天及 2 2 (16- 32 )天。骨髓像显示各系造血均恢复。 7例应用染色体检查 ,8例应用HLA位点 ,4例应用血型 ,1例应用DNA指纹检测 ,植入鉴定结果除 1例复发患者于移植后 2个月骨髓复发植入鉴定为供、受者嵌合外 ,其他患者均呈持续全部稳定植入。移植后发生I度急性GVHD 8例 ,II-IV度GVHD 5例 ,可评价的慢性GVHD共 8例。结论 :供者应用G CSF后采髓 ,加大预处理剂量 ,联合应用作用机理不同的多种免疫抑制剂进行HLA单倍体的骨髓移植 ,可跨越人类HLA多样性屏障。     

A single dose of 6 or 12 mg of pegfilgrastim for peripheral blood progenitor cell mobilization results in similar yields of CD34+ progenitors in patients with multiple myeloma

BACKGROUND: Current regimens for peripheral blood progenitor cell (PBPC) mobilization in patients with multiple myeloma are based on daily subcutaneous injections of granulocyte-colony-stimulating factor (G-CSF) starting shortly after cytotoxic therapy. Recently a polyethylene glycol-conjugated G-CSF (pegfilgrastim) was introduced that has a substantially longer t(1/2) than the original formula. STUDY DESIGN AND METHODS: The use of pegfilgrastim was examined at two dose levels for PBPC mobilization in patients with Stage II or III multiple myeloma. Four days after cytotoxic therapy with cyclophosphamide (4 g/m(2)), a single dose of either 6 mg pegfilgrastim (n = 15) or 12 mg pegfilgrastim (n = 15) or daily doses of 8 microg per kg unconjugated G-CSF (n = 15) were administered. The number of circulating CD34+ cells was determined during white blood cell (WBC) recovery, and PBPC harvesting was performed by large-volume apheresis. RESULTS: Pegfilgrastim was equally potent at 6 and 12 mg with regard to mobilization and yield of CD34+ cells. No dose dependence was observed because CD34+ cell concentration peaks were 131 and 85 per microL, respectively, and CD34+ cell yield was 10.2 x 10(6) and 7.4 x 10(6) per kg of body weight, respectively. Pegfilgrastim in either dose was associated with a more rapid WBC recovery (p = 0.03) and an earlier performance of the first apheresis procedure (p < 0.05) in comparison to unconjugated G-CSF. No difference regarding CD34+ cell maximum and yield could be observed. CONCLUSION: A single dose of 6 mg pegfilgrastim is equally potent as 12 mg for mobilization and harvest of PBPCs in patients with multiple myeloma. Because no dose dependency was seen at these dose levels, this might be also true for even smaller doses.     

The dose of granulocyte-colony-stimulating factor after chemopriming treatment does not influence apheresis yield of progenitor cells: a retrospective study of 91 cases

BACKGROUND: The optimal dose of post-chemotherapy granulocyte-colony-stimulating factor (G-CSF) administration before peripheral blood progenitor cell (PBPC) collection has not been determined as yet, although 5 microg per kg per day has been recommended as the standard dose. This study retrospectively analyzed the effect of G-CSF dose on peripheral blood CD34+ cell collection from 91 patients with hematologic malignancies. STUDY DESIGN AND METHODS: Various doses of G-CSF were administered after several chemotherapeutic PBPC mobilization regimens. According to the dose of G-CSF administered, patients were assigned to two groups. Group 1 included 46 patients who received a low dose of G-CSF (median, 3.6 [range, 2.8-4.6] microg/kg/day). Group 2 included 45 patients who received a standard G-CSF dose of 6.0 (5.5-8. 1) microg per kg per day. Patients in the two groups were matched for age, diagnosis, previous therapy, and chemotherapeutic PBPC mobilization regimens. RESULTS: No difference was observed in the median number of CD34+ cells harvested from each group.The number of leukapheresis procedures necessary to obtain a minimum of 3 x 10(6) CD34+ cells per kg was the same in both groups, and the percentage of patients who failed to achieve adequate PBPC collections was similar in the two groups. CONCLUSION: The administration of low-dose G-CSF after chemotherapy appears equivalent to administration of the standard dose in achieving satisfactory PBPC collection.This approach could allow significant savings in medical cost. A randomized and prospective study is necessary, however, to assess the validity of these conclusions.     

Equivalent mobilization and collection of granulocytes for transfusion after administration of glycosylated G-CSF (3 microg/kg) plus dexamethasone versus glycosylated G-CSF (12 microg/kg) alone

BACKGROUND: The aim of this study was to find a regimen for mobilization and collection of granulocytes that combines low-dose G-CSF administration with satisfactory PMN mobilization and apheresis at a low rate of donor adverse reactions. STUDY DESIGN AND METHODS: In a prospective study, 52 healthy unrelated volunteers received a single subcutaneous injection of glycosylated G-CSF (Lenograstim Chugai-Pharma, Frankfurt, Germany) at medians of 3.1 (range, 2.4-3.6) microg per kg plus dexamethasone (8 mg orally; n = 29) or at 11.8 (7.1-18.5) microg of lenograstim per kg (p < or = 0.0001) without dexamethasone (n = 23) and underwent standard apheresis using the PMN program of a cell separator (Spectra, COBE [now Gambro] BCT). WBC and PMN mobilization results and apheresis yields were compared and the severity and clinical significance of donor adverse reactions was evaluated. RESULTS: For the low-dose G-CSF plus dexamethasone versus the high-dose G-CSF alone group, similar mobilization results were observed for WBCs with 31.3 (19.1-44.9) x 10(9) per L versus 27.5 (19.2-44.0) x 10(9) per L (p = 0.21, NS) and PMNs with 29.0 (17.6-42.2) x 10(9) per L versus 25.2 (16.2-39.0) x 10(9) per L (p = 0.08, NS). The PMN apheresis yields were equal with 70 (39-139) x 10(9) per unit with low-dose G-CSF versus 68 (33-120) x 10(9) per unit in the high-dose G-CSF group (p = 0.83, NS). Regarding donor adverse reactions, 7 out of 29 (24%) and 8 out of 23 donors (35%) reported moderate or severe symptoms. The character of these reactions was different; symptoms of greater clinical significance and a higher need for analgesics were observed in the high-dose G-CSF group. CONCLUSIONS: A Lenograstim dose of 3 microg per kg plus DXM assures effective PMN mobilization and acceptable apheresis components. The combination of glycosylated G-CSF with DXM allows a significant dose reduction in G-CSF for PMN mobilization and collection as compared with higher G-CSF doses alone. In the high-dose G-CSF mobilization group, adverse reactions were more severe and required more analgesics.     

A dose-response analysis of lenograstim plus dexamethasone for neutrophil mobilization and collection

BACKGROUND: The objective was to evaluate the dose-response relationship of lenograstim plus dexamethasone for neutrophil mobilization and collection. STUDY DESIGN AND METHODS: In a prospective study, 260 healthy volunteers received oral dexamethasone (8 mg) plus a single subcutaneous injection of glycosylated granulocyte-colony-stimulating factor (G-CSF; lenograstim) at medians of 1.5 (1.0-2.3) microg per kg (n = 43), 3 (2.4-4.1) microg per kg (n = 73), 6 (4.3-7.9) microg per kg (n = 123), and 12 (8.2-17.2) microg per kg (n = 21) and underwent neutrophil collections with a polymorphonucleated neutrophil (PMN) program. White blood cell (WBC) counts and PMN mobilization and collection results were compared, and the severity and clinical significance of donor adverse reactions were evaluated. Fifty-two neutropenic patients (29 children, 23 adults) underwent 271 neutrophil transfusions (GTXs) every other day to maintain WBC levels continuously above 0.5 x 10(9) per L. RESULTS: Within the dose range 1.5, 3, and 6 microg per kg, each doubling step was associated with a 10 to 15 percent PMN increase in peripheral blood up to 32.8 (19.1-49.2) x 10(9) per L (6 microg/kg; p 相似文献   

Kinetics of PBPC mobilization by cyclophosphamide, as compared with that by epirubicin/paclitaxel followed by G-CSF support: implications for optimal timing of PBPC harvest

BACKGROUND: Limited information is available on the mobilization kinetics of autologous PBPCs after induction with various chemotherapy regimens. With PBPC mobilization in patients with breast cancer used as a model for chemotherapy-induced PBPC recruitment, the kinetics of progenitor cells mobilized either with cyclophosphamide (CY) or epirubicin/paclitaxel (EPI-TAX) followed by the administration of G-CSF was compared. STUDY DESIGN AND METHODS: The study included a total of 86 patients with breast cancer (stage II-IV) receiving either CY (n = 39) or EPI-TAX (n = 47), both followed by G-CSF support. The progenitor cell content in peripheral blood and apheresis components was monitored by flow cytometric enumeration of CD34+ cells. PBPC collection was started when the threshold of >20 x 10(6) CD34+ cells per L of peripheral blood was reached. RESULTS: The PBPC collection was begun a median of 9 days after the administration of EPI-TAX followed by G-CSF support, as compared to a median of 13 days after mobilization with CY plus G-CSF. After treatment with CY, the total numbers of PBPCs peaked on Day 1 of apheresis, and they rapidly declined thereafter. In contrast, treatment with EPI-TAX followed by G-CSF administration led to a steady mobilization of CD34+ cells during leukapheresis. The difference in the mobilization patterns with CY and EPI-TAX resulted in a greater yield of CD34+ cells per L of processed blood volume. Compared to EPI-TAX, mobilization with CY required the overall processing of 30 percent less whole-blood volume to reach the target yield of > or = 10 x 10(6) CD34+ cells per kg of body weight. After a median of three apheresis procedures, however, both CY+G-CSF and EPI-TAX+G-CSF were equally effective in obtaining this target yield. CONCLUSION: These results imply that specific PBPC mobilization as part of a given chemotherapy regimen should be taken into consideration before the planning of a PBPC harvest.     

Successful mobilization of peripheral blood HPCs with G-CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU-GM with chemotherapy and G-CSF

BACKGROUND: Mobilization with chemotherapy and G-CSF may result in poor peripheral blood HPC collection, yielding <2 x 10(6) CD34+ cells per kg or <10 x 10(4) CFU-GM per kg in leukapheresis procedures. The best mobilization strategy for oncology patients remains unclear. STUDY DESIGN AND METHODS: In 27 patients who met either the CD34 (n = 3) or CFU-GM (n = 2) criteria or both (n = 22), the results obtained with two successive strategies-that is, chemotherapy and G-CSF at 10 microg per kg (Group 1, n = 7) and G-CSF at 10 microg per kg alone (Group 2, n = 20) used for a second mobilization course-were retrospectively analyzed. The patients had non-Hodgkin's lymphoma (5), Hodgkin's disease (3), multiple myeloma (5), chronic myeloid leukemia (1), acute myeloid leukemia (1), breast cancer (6), or other solid tumors (6). Previous therapy consisted of 10 (1-31) cycles of chemotherapy with additional chlorambucil (n = 3), interferon (n = 3), and radiotherapy (n = 7). RESULTS: The second collection was undertaken a median of 35 days after the first one. In Group 1, the results of the two mobilizations were identical. In Group 2, the number of CD34+ cells per kg per apheresis (0.17 [0.02-0.45] vs. 0.44 [0.11-0.45], p = 0. 00002), as well as the number of CFU-GM (0.88 [0.00-13.37] vs. 4.19 [0.96-21.61], p = 0.00003), BFU-E (0.83 [0.00-12.72] vs. 8.81 [1. 38-32.51], p = 0.00001), and CFU-MIX (0.10 [0.00-1.70] vs. 0.56 [0. 00-2.64], p = 0.001134) were significantly higher in the second peripheral blood HPC collection. However, yields per apheresis during the second collection did not significantly differ in the two groups. Six patients in Group 1 and 18 in Group 2 underwent transplantation, and all but one achieved engraftment, with a median of 15 versus 12 days to 1,000 neutrophils (NS), 22 versus 16 days to 1 percent reticulocytes (NS), and 26 versus 26 days to 20,000 platelets (NS), respectively. However, platelet engraftment was particularly delayed in many patients. CONCLUSION: G-CSF at 10 microg per kg alone may constitute a valid alternative to chemotherapy and G-CSF to obtain adequate numbers of peripheral blood HPCs in patients who previously failed to achieve mobilization with chemotherapy and G-CSF. This strategy should be tested in prospective randomized trials.     

Mobilization of peripheral blood stem cells in high-risk breast cancer patients using G-CSF after standard dose docetaxel

Chemotherapy, in addition to recombinant growth factors, has been effective in mobilizing stem cells. Unfortunately, the use of chemotherapy for this purpose has resulted in profound myelosuppression and increased morbidity. Docetaxel, the single most active agent in the treatment of advanced breast cancer, was evaluated for its potential to mobilize stem cells when given at conventional doses followed by granulocyte colony-stimulating factor (G-CSF). Sixteen high-risk breast cancer patients were mobilized with a regimen consisting of docetaxel (100 mg/m2) followed by daily G-CSF (10 microg/kg), beginning 72 h after the docetaxel, and continuing until completion of the apheresis. The median white blood cell count (WBC) nadir was 1,000/microl (range 500 to 4000/microl ) occurring a median of 6 days (range 4 to 9 days) after the docetaxel. No patient experienced a neutropenic febrile episode due to the mobilization regimen. The median time interval for initiating the apheresis was 8 days (range 6 to 11 days) following the docetaxel. The median number of apheresis was 2 (range 1 to 3) in each patient. Stem cell recovery as measured by the CD34 cell count x 10(6)/kg was a median of 5.2 (range 1.4 to 15.1). A significant correlation was found between CFU-GM, BFU-E, and CFU-GEMM/kg and CD34 cells/kg (r = 0.891, 0.945, and 0.749, respectively, p < 0.001). When our results were compared to a matched cohort receiving G-CSF alone, the docetaxel group demonstrated a superior CD34 cells/kg yield (p = <0.001). Following myeloablative chemotherapy consisting of thiotepa and cyclophosphamide with or without carboplatinum, the hematopoetic recovery determined by an absolute neutrophil count (ANC) of greater than 500/microl and an unsupported platelet count of > or =20,000/microl for 48 h, was a median of 10 days (range 9 to 14 days) and 10 days (range 8 to 30 days), respectively. The results demonstrate that conventional dose docetaxel, combined with G-CSF, is an effective mobilization regimen with minimal toxicity in high-risk breast cancer patients.     

Rapid succession of peripheral blood progenitor cell mobilization cycles in patients with chronic heart failure: effects on the hematopoietic system

BACKGROUND: Circulating hematopoietic peripheral blood progenitor cells (PBPCs) may contribute to the regeneration of nonhematopoietic organs. An increase in circulating PBPC numbers may enhance this process. Therefore, an exploratory trial of repeated PBPC mobilization in patients with chronic heart failure was conducted. The safety and cardiovascular efficacy data have been described elsewhere. In the hematopoietic system, the trial offered an opportunity to study several new aspects of granulocyte-colony-stimulating factor (G-CSF) action. STUDY DESIGN AND METHODS: Fourteen male patients with chronic heart failure were treated successively with G-CSF (four 10-day treatment periods interrupted by treatment-free intervals of equal length; daily dose adjustment to maintain a white blood cell [WBC] count of 45 x 10(9)-50 x 10(9)/L). RESULTS: G-CSF induced a rapid increase in cells of all WBC lineages with return to levels equal to (neutrophilic, eosinophilic, and basophilic granulocytes) or lower than those before treatment (monocytes, lymphocytes) during the treatment-free intervals. Red cell counts remained unchanged, but platelet counts decreased followed by rebound thrombocytosis. The extent of CD34+ cell mobilization was highly variable. For each patient, the changes induced were identical through all cycles, but the G-CSF dose required in the first cycle was significantly higher than in subsequent cycles. In the cohort of patients, an inverse correlation was observed between the WBC level reached and the dose of G-CSF administered. CONCLUSIONS: Rapid alternation between PBPC mobilization and recovery periods is feasible, with identical alterations in all treatment cycles. G-CSF responsiveness varies among patients and is increased by pretreatment with G-CSF.     

rhIL-11联合rhG-CSF动员小鼠外周血造血干/祖细胞的研究

目的　研究rhIL 11对小鼠巨核系造血干 /祖细胞的动员作用。方法　rhIL 112 5 0μg·kg-1·d-1或联合rhG CSF 2 5 0 μg·kg-1·d-1给C5 7BL/ 6小鼠皮下注射 1～ 7d ,观察用药前和用药第 3,5 ,7,9天小鼠外周血白细胞、血小板计数 ,CD34 +细胞比例 ,CFU GM、CFU MK、CFU E的数量变化。结果　单用rhIL 11或与rhG CSF联合使用时 ,外周血白细胞、血小板、CD34 +细胞比例及各种造血细胞集落数明显高于对照组 (P <0 .0 1)。在含有IL 11的实验组中 ,CFU MK明显高于rhG CSF组 (P <0 .0 1)。结论　rhIL 11可升高外周血白细胞、血小板 ,同时增加外周血CD34 +细胞的比例 ,提高粒、红、巨核系造血细胞集落形成单位的数量 ,特别是对CFU MK作用较强 ;与rhG CSF联合使用对动员骨髓造血干 /祖细胞进入外周血有明显的协同作用。