Allogeneic blood stem cell transplantation: considerations for donors.
Allogeneic blood stem cell transplantation: considerations for donors.
复制标题
同种异体造血干细胞移植：供者的注意事项。
DOI：
10.1182/blood.v90.3.903.903_903_908
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发表时间：
1997
期刊：
影响因子：
20.3
通讯作者：
R. Champlin
中科院分区：
文献类型：
--
作者：
P. Anderlini;M. Korbling;David C. Dale;A. Gratwohl;N. Schmitz;D. Stroncek;C. W. Howe;S. Leitman;M. Horowitz;Eliane Gluckman;S. Rowley;D. Przepiorka;R. Champlin
目前，越来越多地进行异基因外周血干细胞（PBSC）移植，但血液学正常的PBSC供体的安全性考虑尚未得到充分解决。通常使用重组人粒细胞集落刺激因子（rhG-CSF）动员用于从正常供体收集祖细胞。虽然rhG-CSF的短期安全性似乎是可以接受的，但经验仍然有限，其最佳剂量和时间表尚未确定。关于rhG-CSF长期安全性的数据很少，主要来自慢性中性粒细胞减少症或癌症患者的经验。最近，一组积极参与异基因干细胞移植领域的研究人员召开了一个“特别”研讨会，讨论与正常PBSC供体有关的安全问题。在以下几点上达成了一致：（1）根据现有数据，rhG-CSF治疗和PBSC采集在正常供体中具有可接受的短期安全性特征。但是，认识到需要持续进行安全性监测。(2)高达10 μ g/kg/d的rhG-CSF剂量与CD 34+祖细胞的动员（和收集）显示出一致的剂量-反应关系，该剂量对于常规临床使用是可接受的。更高剂量是否具有上级（或成本效益）仍有待确定，它们可能会产生更严重的副作用。显著白细胞增多（任意定义为白细胞计数超过70 × 10（9）/L）的潜在风险一直是一个问题，许多中心进行了rhG-CSF剂量降低，以维持白细胞计数低于该水平。(3)可能发生短暂的献血后血细胞减少，包括粒细胞、淋巴细胞和血小板，至少部分与白细胞分离术相关。这些通常是无症状和自限性的;不一定需要随访血细胞计数。对于预期有献血后血小板减少症（血小板计数< 80至100 × 10（9）/L）的献血者，应考虑回输自体富血小板血浆。(4)献血者应符合适用于单采血小板献血者的合格标准，但也可考虑儿科献血者。任何偏离这些标准的情况都应提供证明文件。目前没有足够的信息明确确定血液学正常供体采集PBSC的明确禁忌症。潜在的禁忌症包括存在炎症、自身免疫或风湿性疾病，以及动脉粥样硬化或脑血管疾病。(5)最好建立一个国际PBSC捐助者登记册，以便利监测该程序的长期影响。鼓励各机构或捐助中心建立自己的PBSC捐助者跟踪系统，最好是采用标准化的数据收集方法。
Allogeneic transplantation of cytokine-mobilized peripheral blood stem cells (PBSCs) is now being increasingly performed, but safety considerations for hematologically normal PBSC donors have not been fully addressed. Progenitors are generally mobilized for collection from normal donors using recombinant human granulocyte colony-stimulating factor (rhG-CSF). Although the short-term safety profile of rhG-CSF seems acceptable, experience remains limited and its optimal dose and schedule have not been defined. Minimal data exist regarding long-term safety of rhG-CSF, primarily derived from experience in patients with chronic neutropenia or cancer. An "ad hoc" workshop was recently convened among a group of investigators actively involved in the field of allogeneic stem cell transplantation to discuss the safety issues pertaining to normal PBSC donors. There was agreement on the following points: (1) On the basis of available data, it appears that rhG-CSF treatment and PBSC collection have an acceptable short-term safety profile in normal donors. However, the need for continued safety monitoring was recognized. (2) rhG-CSF doses up to 10 microg/kg/d show a consistent dose-response relationship with the mobilization (and collection) of CD34+ progenitor cells, and this dose is acceptable for routine clinical use. Whether higher doses are superior (or cost effective) remains to be determined, and they may produce more severe side effects. The potential risks of marked leukocytosis (arbitrarily defined as a leukocyte count of more than 70 x 10(9)/L) have been a concern, and rhG-CSF dose reduction is performed by many centers to maintain leukocyte counts below this level. (3) Transient post donation cytopenias, involving granulocytes, lymphocytes, and platelets, may occur and are at least partly related to the leukapheresis procedure. These are generally asymptomatic and self-limited; follow-up blood counts are not necessarily required. Reinfusion of autologous platelet-rich plasma should be considered for donors with expected postdonation thrombocytopenia (platelet count < 80 to 100 x 10(9)/L). (4) Donors should meet the eligibility criteria which apply to donors of apheresis platelets, with the exception that pediatric donors may also be considered. Any deviation from these criteria should have supporting documentation. There is insufficient information at this time to clearly establish definite contraindications for PBSC collection in a hematologically normal donor. Potential contraindications include the presence of inflammatory, autoimmune, or rheumatologic disorders, as well as atherosclerotic or cerebrovascular disease. (5) The creation of an International PBSC Donor Registry is desirable to facilitate monitoring the long-term effects of the procedure. Individual institutions or donor centers are encouraged to establish their own PBSC donor follow-up system, preferably with a standardized approach to data collection.
影响因子：
20.3
作者：
BENSINGER, WI;WEAVER, CH;BUCKNER, CD
通讯作者：
BUCKNER, CD
晚期血液恶性肿瘤患者异体 CD34+ 外周血干细胞移植。
影响因子：
20.3
作者：
Bensinger,WI;Buckner,CD;Shannon-Dorcy,K;Rowley,S;Appelbaum,FR;Benyunes,M;Clift,R;Martin,P;Demirer,T;Storb,R;Lee,M;Schiller,G
通讯作者：
Schiller,G
重组人粒细胞集落刺激因子（非格司亭）治疗严重慢性中性粒细胞减少症的随机对照 III 期试验。
影响因子：
20.3
作者：
Dale,DC;Bonilla,MA;Davis,MW;Nakanishi,AM;Hammond,WP;Kurtzberg,J;Wang,W;Jakubowski,A;Winton,E;Lalezari,P
通讯作者：
Lalezari,P