通讯作者: 赵明哲, doctorzmz@126.com

DOI：10.12201/bmr.202502.00041

CHEN Li,ZHAO Ming-Zhe*,ZHU Ting-Jun,XIA Bing－Tian,LI Lu－Lu

• 摘要：目的：对恶性血液系统疾病患者外周血造血干细胞动员与采集过程中的影响因素进行分析,探讨血小板在自体干细胞采集过程中的预测价值。方法：回顾性分析2018年9月至2024年3月在金华市中心医院血液科52例行自体干细胞动员及采集的血液系统恶性疾病患者的临床资料。旨在分析患者的年龄、性别、化疗周期数、动员方案、采集机器、骨髓是否缓解等因素,评估上述因素对干细胞采集物中CD34+ 细胞数量的影响,此外,还将探讨在干细胞采集之前,白细胞、单核细胞、淋巴细胞数量以及血小板计数与优质动员之间的相关性。通过使用受试者操作特征曲线(receiver operator characteristic curve,ROC 曲线)来确定采集前血小板的最佳截断值。结果：共52例患者完成了外周血造血干细胞的采集,其中CD34+细胞中位数为6.935(4.046-10.37)×106/kg。采集优质(优质动员组)36例,采集一般(非优质动员)16例。采集前化疗周期数及动员方案对采集的CD34+细胞数有显著性影响,而年龄、性别、采集机器、骨髓中受累情况等对采集的干细胞数量并不产生显著影响。单因素分析血小板数与优质动员相关(P＜0.05),而采集前WBC、MNC、ALC 比较差异无统计学意义(P＞0.05)。进一步多因素分析结果显示,血小板对优质采集具有统计学意义(OR=0.975,95%CI：0.954-0.997)。采集前血小板数量与优质采集相关,采集前PLT的最佳截断cut-off值为0.535。亚组分析显示,输注PLT组的CD34+细胞数和未输注PLT组的CD34+细胞数无明显差异(P＞0.05)。结论：在进行自体造血干细胞动员前,接受多疗程化疗会对其产生不利影响。非稳态动员化疗方案采集CD34+细胞数量优于稳态动员(普乐沙福)方案。根据采集前的血小板数量来确定最佳采集时机,有助于提升采集的成功率。血小板不仅和优质动员相关,还可能是促进干细胞的产生的一个重要因素。

  关键词： 恶性血液系统疾病; 自体外周血造血干细胞移植; 动员; 血小板

   

  Abstract: Objective：This study aims to examine the elements influencing the mobilization and retrieval of hematopoietic stem cells from peripheral blood Objective：: This study aims to examine the factors that affect the mobilization and collection of peripheral blood hematopoietic stem cells in patients diagnosed with malignant hematological disorders. Additionally, it seeks to investigate the predictive significance of platelet levels during the autologous stem cell collection process. Methods：Clinical data of 52 cases of patients with malignant diseases of the haematological system who underwent autologous stem cell mobilisation and collection from September 2018 to March 2024 in the Department of Haematology of Jinhua Central Hospital were retrospectively analysed. Factors such as patients age, gender, number of chemotherapy cycles, mobilisation regimen, collection machine, and whether the bone marrow was in remission were analysed to assess the influence of the above factors on CD34+ counts in stem cell collection, and the correlation between the number of leukocytes, monocytes, lymphocytes, and platelets prior to collection and high-quality mobilisation was also analysed. The optimal cut-off value of platelets before collection was calculated by applying the receiver operator characteristic curve (ROC curve).Results: Effectiveness of haematopoietic stem cell mobilisation and collection Fifty-two patients underwent peripheral blood haematopoietic stem cell collection, and the median number of CD34+ cells obtained was 6.935 (4.046-10.37) × 106/kg. The quality of mobilisation was high in 36 cases (high quality mobilisation group) and average in 16 cases (non-high quality mobilisation group). The number of pre-collection chemotherapy cycles and mobilisation regimen had a significant effect on the number of CD34+ cells collected, whereas age, gender, collection machine, and bone marrow involvement or not had no significant effect on the number of stem cells collected. Univariate analysis of platelet count was associated with quality mobilisation (P＜0.05), whereas but the difference was not statistically significant when comparing WBC, MNC and ALC before collection, (P＞0.05). Further multifactorial analysis showed that the shadow of platelets on quality collection was statistically significant (OR=0.975, 95% CI: 0.954-0.997).Pre-collection platelet count correlated with quality collection and the optimal cut-off cut-off value for pre-collection PLT was 0.535. Conclusion: Multi-course chemomerapy before collection is poor factor negatively impacting on auto-PBSCs mobilization．Non-steady-state mobilisation chemotherapy regimens collected a better number of CD34+ cells than steady state mobilisation (plerixafor) regimens.Determining the appropriate timing of collection by pre-collection platelet count can improve the success of collection. Platelets are not only associated with quality mobilization, but may also be an important factor in promoting stem cell production.

  Key words: malignant hematological disease; autologous peripheral blood stem cell transplantation; mobilization; PLT

  提交时间：2025-02-21

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• 序号	提交日期	编号	操作
  1	2025-01-14	bmr.202502.00041V1	下载

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