Harvest quality and factors affecting collection and engraftment of CD34+ cells in patients with breast cancer scheduled for high-dose chemotherapy and peripheral blood progenitor cell support.
Harvest quality and factors affecting collection and engraftment of CD34+ cells in patients with breast cancer scheduled for high-dose chemotherapy and peripheral blood progenitor cell support.
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计划接受高剂量化疗和外周血祖细胞支持的乳腺癌患者的收获质量和影响 CD34 细胞收集和植入的因素。
DOI：
10.1089/scd.1.1997.6.61
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Hesdorffer,CS
中科院分区：
文献类型：
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作者：
Papadopoulos,KP;Ayello,J;Tugulea,S;Heitjan,DF;Williams,C;Reiss,RF;Vahdat,LT;Suciu-Foca,N;Antman,KH;Hesdorffer,CS
采用CFU-GM和CD34+细胞计数法对45例接受环磷酰胺、硫代替巴和卡铂(CTCb)强化化疗的高危转移性乳腺癌患者的外周血祖细胞(PBPC)采集和植入的影响因素进行了研究。用标准乳腺癌方案或环磷酰胺(1.5g/m2)或5μg/kg/d的G-CSF5 mg/kg/d动员外周血，联合应用CTCb后的造血支持。L外周血CD34+细胞/μ与收获CD34+/kg(r=0.73p<；0.0001)、采集粒-GM与CD34+细胞/kg(r=0.5p<；0.0001)呈显著正相关。除了CD34+细胞计数外，CFU-GM克隆性分析没有临床用途，后者允许实时决定是否采集。多元逐步回归发现，先前化疗周期的数量是CD34+细胞产量的唯一有意义的临床预测因素。对于34例接受PBPC支持的CTCb患者，多元逐步回归分析显示中性粒细胞植入CFU-GM和CD34+细胞/kg、CD34+细胞/kg和血小板化疗周期数分别是最好的预测因子。在这些经过深度治疗的乳腺癌患者中，87%的患者获得的阈值剂量为1×106 CD34+细胞/公斤，足以确保15天内植入。尽管中性粒细胞(9天比8天，p=0.007)和血小板(12天比9天，p=0.006)移植的中位时间显著延长，但接受1-2.5x106CD34+细胞/kg和大于2.5x106CD34+细胞/kg的患者在住院时间和血液制品使用方面没有显著差异。建立的≥1×106 CD34+细胞/公斤的阈值将允许更有信心地考虑在包括CTCb在内的连续高剂量方案中使用该阈值剂量的等量用于造血支持。
The use of CFU-GM and CD34+ cell enumeration for assessing harvest quality and factors affecting peripheral blood progenitor cell (PBPC) harvest and engraftment were investigated in 45 women with high-risk and metastatic breast cancer scheduled for dose-intensive cyclophosphamide, thiotepa, and carboplatin (CTCb). PBPC were mobilized with standard breast cancer regimens or cyclophosphamide (1.5 g/m2) and 5 μg/kg/day G-CSF and used together with G-CSF for hematopoietic support post-CTCb. There was a significant correlation between peripheral blood CD34+ cells/μl and harvest CD34+/kg (r = 0.73,p< 0.0001) and between harvest CFU-GM and CD34+ cells/kg (r = 0.5,p< 0.0001). CFU-GM clonogenic assays were of no clinical use beyond that of CD34+ cell enumeration, with the latter allowing for real-time decisions regarding harvesting. Multiple stepwise regression identified the number of prior chemotherapy cycles as the only significant clinical predictor of CD34+ cell yield. For 34 patients proceeding to CTCb with PBPC support, multiple stepwise regression identified as the best predictors for engraftment CFU-GM and CD34+ cells/kg for neutrophils and CFU-GM, CD34+ cells/kg, and the number of prior cycles of chemotherapy for platelets, respectively. A threshold dose of 1 × 106CD34+ cells/kg, obtained in 87% of these heavily pretreated breast cancer patients, was adequate to ensure engraftment within 15 days. There was no significant difference in length of hospital stay or blood product use between patients receiving 1–2.5 × 106CD34+ cells/kg and greater than 2.5 × 106CD34+ cells/kg, although median time to engraftment of neutrophils (9 days versus 8 days,p= 0.007) and platelets (12 days versus 9 days,p= 0.006) was significantly longer. The established threshold of ≥1 × 106CD34+ cells/kg will allow for more confident consideration of using aliquots of this threshold dose for hematopoietic support in sequential high-dose regimens inclusive of CTCb.