Transfusions of granulocyte‐colony‐stimulating factor‐mobilized granulocyte components to allogeneic transplant recipients: analysis of kinetics and factors determining posttransfusion neutrophil and platelet counts
Transfusions of granulocyte‐colony‐stimulating factor‐mobilized granulocyte components to allogeneic transplant recipients: analysis of kinetics and factors determining posttransfusion neutrophil and platelet counts
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将粒细胞集落刺激因子动员的粒细胞成分输注至同种异体移植受者：分析动力学和决定输血后中性粒细胞和血小板计数的因素
作者：
D. Adkins;G. Spitzer;M. Johnston;W. Velasquez;F. Dunphy;P. Petruska
背景：粒细胞集落刺激因子(G-CSF)是一种安全有效的中性粒细胞动员药物，其在白细胞分离(LA)过程中的细胞产量一直高于其他药物。LA组分还含有血小板，其临床相关性尚不清楚。研究设计和方法：本研究描述了从接受G-CSF(n=10；最多3次LA程序/供者)的兄弟姐妹捐献者中采集的三种粒细胞输注后ANC和血小板计数增加的动力学，并分析了决定因素。每隔一天开始给受者输血(n=10)。异基因骨髓移植(BMT)后第1天。结果：输注G-CSF动员的LA组分后，受体ANCs显著、持续增加。在输注供体LA成分的第1、3和5天，ANCs的平均峰值增量分别为1195、729和631个微升。输血后平均ANC达到或高于基线(输血前)值的时间为25至37小时，这取决于BMT后服用该成分的时间。未观察到LA组分粒细胞剂量、受者基线ANC或体温升高与输血后ANC增量之间的一致关系。在LA成分中存在大量的血小板(平均2.55×10(11))，这导致LA成分输注后1小时的平均血小板计数较基线显著增加。在第1天和第7天之间，接受LA成分输血的研究患者严重中性粒细胞减少的持续时间较短，需要非捐赠者血小板输注的患者比例低于没有接受LA成分输注的类似历史对照组。结论：给异基因骨髓移植受者输注G-CSF动员的、人类白细胞抗原配型相匹配的LA成分后，ANC和血小板计数显著且持续增加。在检查的范围内，中性粒细胞剂量和中性粒细胞增加之间的关系没有被证明。
BACKGROUND: Granulocyte‐colony‐stimulating factor (G‐CSF) is a safe and effective agent for mobilization of neutrophils in normal donors, consistently resulting in cell yields per leukapheresis (LA) procedure that are superior to those with other agents. LA components also contain platelets, whose clinical relevance is unknown. STUDY DESIGN AND METHODS: This study describes the kinetics of and analyzes the factors determining the ANC and platelet count increments seen with each of three transfusions of granulocytes collected from HLA‐matched sibling donors receiving G‐CSF (n=10; maximum of 3 LA procedures/donor). The transfusions were given to recipients (n=10) on alternate days beginning. Day 1 after allogeneic bone marrow transplant (BMT). RESULTS: Significant, sustained increments in the recipient ANCs were observed after the transfusion of G‐CSF‐mobilized LA components. The mean peak posttransfusion increments in the ANCs were 1195, 729, and 631 per microL with transfusion of donor LA components on Days 1, 3, and 5, respectively. The length of time that the mean posttransfusion ANC was at or above the baseline (pretransfusion) value was 25 to 37 hours, depending on the post‐BMT day when the component was administered. No consistent relationship was observed between LA component granulocyte dose, baseline recipient ANC, or temperature elevation and post‐transfusion ANC increments. Large numbers of platelets (mean, 2.55 × 10(11)) were present in LA components, and this resulted in significant increments from baseline in the mean platelet count 1 hour after LA component transfusions. Between Days 1 and 7, the duration of severe neutropenia was shorter and the percentage of patients requiring nondonor platelet transfusions was less in study patients who received LA component transfusions than in a similar historical control group who did not. CONCLUSION: The transfusion of G‐CSF‐mobilized, HLA‐matched LA components to allogeneic BMT recipients resulted in significant and sustained increments in the ANC and the platelet count. Within the range examined, a relationship between neutrophil dose and an increment in the ANC was not demonstrated.
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