Korean J Hematol 2001; 36(1):
Published online March 31, 2001
© The Korean Society of Hematology
악성 혈액질환에서 GM-CSF (Leucogen®)를 기저로 가동화된 동종말초조혈모세포를 이용한 단기 이식성적보고
곽동석, 이영택, 채의수, 서광운, 박성원, 백진호, 김종광, 김동환, 정진태, 박소향, 손상균, 서장수, 이규보
경북대학교 의과대학 내과학교실,
경북대학교 의과대학 임상병리학교실,
경북대학교 의과대학 암연구소
Allogeneic Peripheral Blood Stem Cell Transplantation in Hematological Malignancies : Stem Cell Mobilization with GM-CSF alone or a combination of GM-CSF and G-CSF from Normal Healthy Donors
Background: Granulocyte-colony stimulating factor (G-CSF) has been used in normal heathy donors to mobilize hematopoietic progenitors. Recently, it was reported that an addition of granulocyte-macrophage-CSF (GM-CSF) mobilized more
primitive
CD34+ subsets than did G-CSF alone. We investigated the result of the allogeneic peripheral blood stem cell transplantation (PBSCT) with stem cells mobilized with GM-CSF alone or a combination of GM-CSF and G-CSF from normal healthy donors in
hematological malignancies.
Methods: Twenty-nine patients with hematologic malignancies had allogeneic PBSCT from normal sibling donors. Nine healthy donors were mobilized with GM-CSF (Leucogen®) alone and 20 with a combination of GM-CSF and G-CSF
(Leucogen®). After 5~8 days of cytokine treatment, PBSCs were collected by large volume leukapheresis and analyzed.
Results: Stem cells were collected from the HLA matched normal healthy sibling donors. The mean harvested cell content was 8.74±3.22×108 MNCs/㎏, 15.65±16.02×10 6 CD34+ cells/㎏ of the patients. There were
significant
differences in the harvested MNC count between mobilization group with GM-CSF alone and group with a bination of GM-CSF and G-CSF. Observed side effects of cytokine mobilization were myalgia (76%), headache (41%), febrile sense (24%) and skin
rash
(10%). These complications disappeared within 48 hours after discontinuation of cytokines. The medican interval to achieve a WBC count >500/uL was 15.00±4.23 days, and 14.00±33.01 days to a platelet coung >20,000/uL. The actual incidence of acute
GVHD
was 36.4%, 22.7%, and 4.5% for skin, GIT, and liver, respectively. Immunosuppressant responsive chronic GVHD developed in 63.1% (12/19) of assessable patients including 6 cases who had donor lymphocyte infusions.
Conclusion: In this study, GM-CSF based cytokine mobilization was able to collect sufficient numbers of stem cells and allow rapid engraftment in the allogeneic PBSCT. Mobilization protocol with a combination of GM-CSF and G-CSF seemed to
be
superior to GM-CSF alone. Acute GVHD in patients with allogeneic PBSCT didn't appear to be more severe than in patients undergoing allogeneic BMT.
Keywords Allogeneic PBSCT; GM-CSF; GVHD; Stem Cell Mobilization;
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Korean J Hematol 2001; 36(1): 25-34
Published online March 31, 2001
Copyright © The Korean Society of Hematology.
악성 혈액질환에서 GM-CSF (Leucogen®)를 기저로 가동화된 동종말초조혈모세포를 이용한 단기 이식성적보고
곽동석, 이영택, 채의수, 서광운, 박성원, 백진호, 김종광, 김동환, 정진태, 박소향, 손상균, 서장수, 이규보
경북대학교 의과대학 내과학교실,
경북대학교 의과대학 임상병리학교실,
경북대학교 의과대학 암연구소
Allogeneic Peripheral Blood Stem Cell Transplantation in Hematological Malignancies : Stem Cell Mobilization with GM-CSF alone or a combination of GM-CSF and G-CSF from Normal Healthy Donors
Dong Seok Kwak, Young Taek Lee, Yee Soo Chae, Kwang Woon Seo, Sung Won Park, Jin Ho Baek, Jong Gwang Kim, Dong Hwan Kim, Jin Tae Jung, So Hyang Park, Sang Kyun Sohn, Jang Soo Suh, Kyu Bo Lee
Department of Internal Medicine, Clinical Pathology and Cancer Research Center Kyungpook National University, School of Medicine Taegu, korea
Abstract
Background: Granulocyte-colony stimulating factor (G-CSF) has been used in normal heathy donors to mobilize hematopoietic progenitors. Recently, it was reported that an addition of granulocyte-macrophage-CSF (GM-CSF) mobilized more
primitive
CD34+ subsets than did G-CSF alone. We investigated the result of the allogeneic peripheral blood stem cell transplantation (PBSCT) with stem cells mobilized with GM-CSF alone or a combination of GM-CSF and G-CSF from normal healthy donors in
hematological malignancies.
Methods: Twenty-nine patients with hematologic malignancies had allogeneic PBSCT from normal sibling donors. Nine healthy donors were mobilized with GM-CSF (Leucogen®) alone and 20 with a combination of GM-CSF and G-CSF
(Leucogen®). After 5~8 days of cytokine treatment, PBSCs were collected by large volume leukapheresis and analyzed.
Results: Stem cells were collected from the HLA matched normal healthy sibling donors. The mean harvested cell content was 8.74±3.22×108 MNCs/㎏, 15.65±16.02×10 6 CD34+ cells/㎏ of the patients. There were
significant
differences in the harvested MNC count between mobilization group with GM-CSF alone and group with a bination of GM-CSF and G-CSF. Observed side effects of cytokine mobilization were myalgia (76%), headache (41%), febrile sense (24%) and skin
rash
(10%). These complications disappeared within 48 hours after discontinuation of cytokines. The medican interval to achieve a WBC count >500/uL was 15.00±4.23 days, and 14.00±33.01 days to a platelet coung >20,000/uL. The actual incidence of acute
GVHD
was 36.4%, 22.7%, and 4.5% for skin, GIT, and liver, respectively. Immunosuppressant responsive chronic GVHD developed in 63.1% (12/19) of assessable patients including 6 cases who had donor lymphocyte infusions.
Conclusion: In this study, GM-CSF based cytokine mobilization was able to collect sufficient numbers of stem cells and allow rapid engraftment in the allogeneic PBSCT. Mobilization protocol with a combination of GM-CSF and G-CSF seemed to
be
superior to GM-CSF alone. Acute GVHD in patients with allogeneic PBSCT didn't appear to be more severe than in patients undergoing allogeneic BMT.
Keywords: Allogeneic PBSCT, GM-CSF, GVHD, Stem Cell Mobilization,
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