CIE及IEV方案在恶性实体瘤儿童自体外周血干细胞动员和采集中的应用

Mobilization and collection of autologous peripheral blood stem cells by CIE or IEV protocol in children with malignant solid tumors

摘要:

目的：自体外周血干细胞移植（APBSCT）是治疗儿童恶性实体瘤的重要方法之一，干细胞动员与采集是决定造血重建的重要因素。本研究采用CIE及IEV动员方案对儿童神经母细胞瘤（NB）及横纹肌肉瘤进行干细胞动员和采集，并对临床效果进行评价。方法：8例IV期NB 患儿采用CIE化疗方案动员，3例III期横纹肌肉瘤患儿采用IEV方案。观察采集干细胞的效果。结果：11例患儿平均采集单个核细胞数（MNC）为(5.55 ±1.43)×108/kg，CD34+ 细胞数为（4.88±2.48）×106/kg，动员并发症少,患儿均能耐受。10例行APBSCT后均获快速造血功能重建，其中1例NB于APBSCT后32 d因合并左心衰竭死亡，余9例患儿APBSCT后60 d复查外周血象稳定。结论：CIE及IEV方案可以安全有效地完成NB及横纹肌肉瘤自体外周血干细胞动员和采集并达到移植要求。

Abstract:

OBJECTIVE: Autologous peripheral blood stem cell transplantation (APBSCT) is an important method for treatment of malignant solid tumors in children. The mobilization and collection of blood stem cells is crucial for APBSCT. This study aimed to evaluate the clinical efficacy of mobilization and collection of blood stem cells by CIE or IEV chemotherapy protocol in APBSCT in children with neuroblastoma (NB) or rhabdomyosarcoma. METHODS: The protocols of CIE (cisplatin, etoposide) and IEV (vincristine, dosfamide, etoposide) were used as mobilization chemotherapy in 8 cases of NB with stage IV and 3 cases of rhabdomysacoma with stage III, respectively. The results of the mobilization of blood stem cells were observed. RESULTS: Of the 11 cases, mononuclear cells (MNC) and CD34+ cells were successfully collected and the volume of MNC and CD34 averaged (5.55±1.43)×108/kg and (4.88±2.48)×106/kg, respectively. No severe complications were observed during the mobilization and collection. A rapid hemopoietic reconstitution was observed in 10 children after APBSCT. One with NB out of the 10 children died of left heart failure 32 days after APBSCT. Others (9 cases) showed a nearly normal result of routine peripheral blood test 60 days after APBSCT. CONCLUSIONS: CIE or IEV protocol is effective and safe for the mobilization and collection of peripheral blood stem cells in children with NB or rhabdomysacoma.