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， 供体的类固醇刺激。为了确定最佳动员 最大限度地提高细胞产量和减少供体不适的时间表 在粒细胞置换术期间，我们设计了一项配对对照研究， 动员时间表20名健康供体接受了3次 白细胞分离术，接受地塞米松（口服8 mg 捐献前12小时）、G-CSF（捐献前16-24小时5微克/kg SQ） 单采术）或地塞米松加G-CSF（相同剂量的D+G）。七 在CS-3000 Plus装置上使用 羟乙基淀粉作为沉淀剂。所有产品均输注至 定性或定量粒细胞缺乏的患者， 危及生命的感染 G-CSF单独给药导致3.5倍增加， 地塞米松加C-CSF的联合治疗导致了4.8倍的增加， 供体外周血粒细胞计数与地塞米松比较 单用地塞米松组分别为6.0 ± 2.3、21.3 ± 5.2和28.9 ± 6.8 分别用G-CSF和D+G × 109个细胞/L）。同样，使用G-CSF 单独或地塞米松和G-CSF的组合导致2.4-和 3.4-产品中粒细胞含量增加1倍， 地塞米松单独给药（从地塞米松单独给药的2.16 ± 0.71增加至5.08 ± 0.71）， 1.10 G-CSF和D+G分别为7.25 ± 1.54 × 1010个细胞）， 地塞米松与G-CSF或D+G之间的所有比较p <0.01。 此外，外周血和产品粒细胞计数均为 当供体服用D+G组合时比单独使用G-CSF（36%）更高（p <0.05）。 血液粒细胞计数增加，产物增加43% 当dexa加入G-CSF中时的粒细胞含量）。单用dexa， 捐献者有失眠或潮红;使用G-CSF，65%有骨痛，头痛， 失眠，疲劳或出汗;这增加到85%与组合 D+G。两名捐献者要求停止G-CSF动员的捐献， 活动疗法带来的不适和不便 在G-CSF中加入地塞米松可显著增加粒细胞 以适度增加捐助者的不便为代价， 粒细胞分离产品的可用性， 高功能细胞数量的增加可能导致 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.