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題 名 | Allogeneic Peripheral Blood Stem Cell Transplantation and Early Detection of Donor Engraftment by Polymerase Chain Reaction=異體週邊造血幹細胞移植,與利用聚合酶連鎖反應早期偵測末自捐贈者之移植體形成 |
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作 者 | 曾成槐; 劉昭儀; 林炯熙; 陳瀅如; 胡惠宇; 雍建輝; 王聲遠; 李俊億; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 97:4 1998.04[民87.04] |
頁 次 | 頁252-260 |
分類號 | 416.175 |
關鍵詞 | 異體週邊造血幹細胞移植; 聚合酶連鎖反應; Stem cell transplantation; Graft-versus-host disease; Polymerase chain reaction; Short tandem repeat genotyping; Granulocyte colony-stimulating factor; |
語 文 | 英文(English) |
英文摘要 | Patients with hematologic malignancy or severe aplastic anemia after myeloablative chemo- and radio therapy were given granulocyte colony-stimulating factor (G-CSF)-mobilized, cryopreserved allogeneic peripheral blood stem cells (PBSCs) from 15 healthy donors who were either human leukocyte antigen (HLA)-matched siblings (n = 13) or haploidentical offspring (2). Polymerase chain reaction-amplified short tandem repeat genotyping was used for early confirmation of donor engraftment after PBSC transplantation (PBSCT). A standard cyclosporine A methotrexate combination was used to prevent acute graft-versus-host disease (GVHD) All donors, including one in the third trimester of pregnancy, tolerated G-CSF administration and 3-day PBSC harvesting procedures well. Engraftment was prompt for all patients; it was verified using a panel of 12 human polymorphic short tandem repeat loci from bone marrow as early as 7 days posttransplantation. This status was maintained until relapse, when mixed chimerism was detected using the polymerase chain reaction. A minimum resurgence of recipient cells to 1% of the population was required to detect chimerism. The median times to recovery of the absolute neutrophil count to greater than 0.5*10□/L and the sustained platelet count to greater than 20*10□/L without transfusion were 10 and 12 days after PBSCT, respectively. Six patients experienced acute GVHD, Grade I in two patients and Grade II in four, including two HLA-haploidentical recipients. Chronic GVHD was noted in three of the 11 patients who were followed for at least 100 days after PBSCT. Ten patients were still alive at the latest follow-up and have been disease free for a median of 278 days (range 60-671). Five patients died from causes other than graft failure: three from leukemia relapse and two from transplant-related complications. The results confirm that G-CSF can be safely administered to healthy donors and that engraftment after allogeneic PBSCT is fast and durable. Complete chimerism can be detected early by genomic analysis. PBSCT may offer an alternative to bone marrow transplantation. |
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