Результаты мобилизации, афереза и аутореинфузии гемопоэтических стволовых клеток у детей с нейробластомой: роль мониторинга количества CD34+ клеток в периферической крови

Статья в Elpub

Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2017; 16: 28-39

Результаты мобилизации, афереза и аутореинфузии гемопоэтических стволовых клеток у детей с нейробластомой: роль мониторинга количества CD34+ клеток в периферической крови

Курникова Е. Е., Кумукова И. Б., Гуз И. В., Хисматуллина Р. Д., Шаманская Т. В., Фадеева М. С., Глушкова С. Ю., Бриллиантова В. В., Варфоломеева С. Р., Трахтман П. Е.

https://doi.org/10.24287/1726-1708-2017-16-1-28-39

Аннотация

Миелоаблативная химиотерапия, сопровождающаяся аутологичной трансплантацией гемопоэтических стволовых клеток, способна улучшить результаты долгосрочной выживаемости пациентов с нейробластомой группы высокого риска, но требует достаточного количества аутологичных периферических стволовых клеток крови. Выполнено 118 аферезов для 116 детей с нейробластомой группы высокого риска. Медиана возраста - 2 года 10 мес. (от 6 мес. до 13 лет), медиана массы тела - 13 кг (от 5,8 до 47 кг). Мобилизация гранулоцитарным колониестимулирующим фактором в дозе 10 мкг/кг инициировалась в момент начинающегося восстановления кроветворения после последнего блока химиотерапии; мониторинг CD34+ клеток в периферической крови проводили с 3-го дня дня от начала мобилизации. Аферез выполняли на следующий день после достижения количества CD34+ клеток 15 в мкл после четырех дней мобилизации. Модификация тактики мобилизации, основанная на данных мониторинга числа CD34+ клеток в ПК, позволила достичь ко дню афереза медианы числа CD34+ клеток 105,27 клеток/мкл (от 14,8 до 714,8). В продукте афереза медиана CD34+/кг составила 14,43106/кг (от 2,68 до 74). Были выявлены достоверная корреляция между дозой CD34+/кг в продукте афереза и уровнем CD34+ клеток в ПК в день афереза (R=0,762; р0,0001), снижение результатов мобилизации и аферезов, если проведено более трех блоков ХТ. Благодаря мониторингу количества циркулирующих в ПК CD34+ клеток и модификации тактики мобилизации стала выполнимой задача сбора адекватной дозы CD34+ клеток за одну процедуру афереза: для 88 (75,86%) из 116 пациентов собрано 10106/кг CD34+ клеток и более, для 100% пациентов - более 2,5106/кг CD34+ за один аферез.

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Pediatric Hematology/Oncology and Immunopathology. 2017; 16: 28-39

Results of mobilization, apheresis and autoreinfusion of hematopoietic stem cells in children with neuroblastoma: role of monitoring the count of CD34+ cells in peripheral blood

Kurnikova E. E., Kumukova I. B., Guz I. V., Chismatullina R. D., Shamanskaya T. V., Fadeeva M. S., Glushkova S. Y., Brilliantova V. V., Varfolomeyeva S. R., Trakhtman P. E.

https://doi.org/10.24287/1726-1708-2017-16-1-28-39

Abstract

Myeloablative chemotherapy with autologous hematopoietic stem cells transplantation, can improve the results of long-term survival in patients with high-risk neuroblastoma. This treatment requires a sufficient number of autologous peripheral blood stem cells. Methods: 118 apheresis procedures was completed for 116 children with high-risk neuroblastoma, the median age was 2 years and 10 months (range, 6 months to 13 years), median body weight of 13 kg (range, 5.8 to 47 kg). Mobilization with G-CSF at a dose of 10 mg/kg was initiated at the time of incipient recovery of hematopoiesis after the last cycle of chemotherapy, monitoring of CD34+ cells in peripheral blood were started on 3rd day from the beginning of mobilization. Apheresis was performed the following day after reaching the number of CD34+ cells >15 cells/μl after 4 consequent days of mobilization. Results: Modification of mobilization, based on CD34+ cells monitoring data, allowed us to reach the median number of CD34+ cells of 105,27 cells/μl (range, 14.8–714.8) at the day of apheresis. The median number of collected CD34+/kg was 14,43×106/kg b.w. (range, 2.68–74). Was revealed a significant correlation between the dose of CD34+/kg b.w in the apheresis product and the level of CD34+ cells in peripheral blood at the day of apheresis (R=0.762; р<0.0001) and decrease of the results of mobilizing results and apheresis efficiency if mobilization was initiated later than after the 3rd course of chemotherapy. Conclusion: By monitoring the number of circulating CD34+ cells in peripheral blood and modification of mobilization tactic, the task to collect an adequate dose of CD34+ cells for autoSCT with one apheresis procedure was feasible. In 88 (75.86%) of the 116 patients we were able to collect 10×106/kg CD34+ cells and more, and 100% of patients collected > 2.5×106/kg CD34+ cells with 1 apheresis.

References

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3. Luksch R., Castellani M. R., Collini P., De Bernardi B., Conte M., Gambini C. et al. Neuroblastoma (Peripheral neuroblastic tumours). Crit Rev Oncol Hematol. 2016;107:163-181.

6. Brodeur G.M., Maris J.M., Yamashiro D.J., Hogarty M.D., White P.S. Biology and genetics of human neuroblastomas. J Pediatr Hematol Oncol. 1997;19(2):93-101.

9. Park J.R., Eggert A., Caron H. Neuroblastoma: biology, prognosis, and treatment. Hematol Oncol Slin North Am. 2010;24(1):65-86.

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22. Maschan A.A., Balashov D.N., Kurnikova E.E., Trakhtman P.E., Boyakova E.V., et al. Efficacy of plerixafor in children with malignant tumors failing to mobilize a sufficient number of hematopoietic progenitors with G-CSF. Bone Marrow Transplant. 2015;50(8):1089-1091.

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Аннотация

Results of mobilization, apheresis and autoreinfusion of hematopoietic stem cells in children with neuroblastoma: role of monitoring the count of CD34+ cells in peripheral blood

Abstract

События