G-CSF AND DEXAMETHASONE TO OPTIMIZE YIELDS OF GRANULOCYTAPHERESIS PROCEDURES

治疗性粒细胞输注的疗效受到以下因素的限制 使用标准淀粉获得的细胞数量相对较少 对捐赠者的类固醇刺激。要确定最佳动员方案 最大限度地提高细胞产量和最大限度减少供体不适的时间表 在粒细胞分离过程中，我们设计了一项配对对照研究，研究对象为 动员时间表。20名健康的捐赠者接受了三次 每次白细胞分离程序，接受地塞米松(8毫克口服 捐献前12小时)，G-CSF(5微克/公斤平方英尺，捐献前16-24小时 或地塞米松+G-CSF(D+G等剂量)。七 在CS-3000 Plus设备上使用 以海藻为沉淀剂。所有产品都被输注到 有定性或定量粒细胞缺陷的患者和 危及生命的感染。 仅使用G-CSF就可导致3.5倍的增加， 地塞米松和C-CSF联合应用可使患者的 供者外周血粒细胞计数与地塞米松的比较 单独使用(从地塞米松的6.0±2.3降至21.3±5.2和28.9±6.8 X109细胞/L分别加G-CSF和D+G)。同样，G-CSF的使用 地塞米松和G-CSF单独或联合使用可导致2.4-和 产品中粒细胞含量增加3.4倍 地塞米松(从2.16±0.71升至5.08+ 细胞总数分别为1.10和7.25±1.54×1010细胞)， P&lt；0.01地塞米松与G-CSF或D+G之间的所有比较。 此外，外周血和产品粒细胞计数均为 供者联合应用D+G与单独使用G-CSF相比(P&lt；0.05)更高(36% 血粒细胞数增加，乘积增加43% G-CSF中加入地塞米松后的粒细胞数)。仅使用DXA，25%的 捐献者有失眠或面色潮红；使用G-CSF，65%的人有骨痛、头痛、 失眠、疲劳或出汗；联合应用后，这一比例增加到85% D+G两名捐赠者要求停止到期的G-CSF动员的捐赠 对于动员方案的不适和不便。 G-CSF中加入地塞米松可显著增加粒细胞 收益的代价是捐赠者的不便和 对粒细胞分离产品的可用性感到不适 高功能细胞数量的增加可能会导致 对这种输血成分的兴趣重新抬头。

The efficacy of therapeutic granulocyte transfusions is limited by the relatively small number of cells obtained using standard starch and steroid stimulation of the donor. To determine an optimal mobilization schedule that would maximize cell yields and minimize donor discomfort during granulocytapheresis, we designed a pair-controlled study of three mobilization schedules. Twenty healthy donors underwent three leukapheresis procedures each, receiving either dexamethasone (8 mg orally 12 hrs prior to donation), G-CSF (5 microgram/kg SQ 16-24 hrs prior to apheresis), or dexamethasone plus G-CSF (D+G in the same doses). Seven liters of whole blood were processed on the CS-3000 Plus device using hetastarch as the sedimenting agent. All products were transfused to patients with qualitative or quantitative granulocyte deficiencies and life-threatening infections. Administration of G-CSF alone led to a 3.5-fold increase and the combination of dexamethasone plus C-CSF led to a 4.8-fold increase in donor peripheral blood granulocyte counts compared with dexamethasone alone (from 6.0 + 2.3 with dexamethasone, to 21.3 + 5.2 and 28.9 + 6.8 x109 cells/L with G-CSF and D+G, respectively). Similarly, use of G-CSF alone or the combination of dexamethasone and G-CSF resulted in 2.4- and 3.4-fold increases in granulocyte content in the product compared with dexamethasone alone (from 2.16 +0.71 with dexamethasone alone to 5.08 + 1.10 and 7.25 + 1.54 x1010 cells total with G-CSF and D+G, respectively), p <0.01 for all comparisons between dexamethasone and either G-CSF or D+G. In addition, both peripheral blood and product granulocyte counts were greater (p <0.05) when donors took combination D+G vs G-CSF alone (36% increase in the blood granulocyte count and 43% increase in product granulocyte content when dexa was added to G-CSF). With dexa alone, 25% of donors had insomnia or flushing; with G-CSF, 65% had bone pain, headache, insomnia, fatigue, or diaphoresis; this increased to 85% with combination D+G. Two donors requested discontinuation of G-CSF-mobilized donations due to the discomfort and inconvenience of the mobilization regimen. Addition of dexamethasone to G-CSF significantly increases granulocyte yields at the expense of a moderate increase in donor inconvenience and discomfort The availability of granulocytapheresis products with markedly increased numbers of highly functional cells is likely to result in a resurgence of interest in this transfusion component.