醫(yī)學(xué)資料 peg-G-CSF在造血干細(xì)胞移植中的應(yīng)用學(xué)習(xí)課件

健康志愿者：PEGG-CSFVSG-CSF

藥動(dòng)學(xué)和藥效學(xué)的比較AmJHematol.2001Apr;66(4):245-51.隨機(jī)雙盲PEGG-CSF10to150microg/kg一次G-CSF5or10microg/kg多次，7天PEGG-CSF提高ANC6-to8倍,CD34+cell提高達(dá)30倍PEGG-CSF60-150microg/kg與G-CSF5-10ug/kg效能相似PEGG-CSF動(dòng)員更多的CFU-GM.PEGG-CSF半衰期3倍，G-CSF不良反應(yīng)：相似

異基因移植：健康人動(dòng)員干細(xì)胞

異基因移植：健康人動(dòng)員干細(xì)胞

接受peg-G-CSF動(dòng)員的小鼠比接受標(biāo)準(zhǔn)G-CSF動(dòng)員小鼠的GVHD發(fā)生率減低AllogeneicdonorC57BL/6animalsG-CSF(2g/dfor6days),asingledoseofpeg-G-CSF(3or12gatday6).EdwardS,etal.BLOOD.2004103:3573-3581peg-G-CSF動(dòng)員的供者損傷T細(xì)胞的功能而且誘導(dǎo)調(diào)節(jié)T細(xì)胞的活性EdwardS,etal.BLOOD.2004103:3573-3581產(chǎn)生IL-10的T調(diào)節(jié)細(xì)胞比例增加！接受PegylatedG-CSF動(dòng)員異基因造血干細(xì)胞移植D0天給予6mgPegylatedG-CSF皮下注射注射后d2-5及d12天監(jiān)測(cè)血細(xì)胞計(jì)數(shù)、生化、CD34+細(xì)胞計(jì)數(shù)d4接受造血干細(xì)胞采集HillJR,etal.BiologyofBloodandMarrowTransplantation.200612:603-607

成功的干細(xì)胞動(dòng)員和移植

pegG-CSFvsG-CSF,多發(fā)性骨髓瘤.

動(dòng)員方案：4g/m(2)CTX12mgPEGG-CSFG-CSF(8.5ug/kg)n=12N=12leukocyterecovery1214CD34+cellpeak1215CD34+cellpeak78111/mulAHSCT:melphalan(200mg/m(2))100daysposttransplantSummary:單次pegfilgrastim聯(lián)合化療可動(dòng)員足夠的CD34+細(xì)胞！BoneMarrowTransplant.2005Jan;35(1):33-6.R-ESHAP+pegG-CSF:

DLBCL干細(xì)胞動(dòng)員R-ESHAP+pegG-CSF:

DLBCL干細(xì)胞動(dòng)員病例分享：津優(yōu)力在臨床實(shí)踐中的應(yīng)用津優(yōu)力在AML自體骨髓移植中的應(yīng)用Case1,47歲，男性，以皮膚出血點(diǎn)起病診斷AML(CBFB/MYH11陽(yáng)性）一療程DA達(dá)完全緩解再次給予DA、MA、中劑量阿糖胞苷經(jīng)CY/TBI預(yù)處理行自體骨髓移植移植后+1，+10，+21給予津優(yōu)力促進(jìn)造血恢復(fù)移植后+25白細(xì)胞逐步恢復(fù)津優(yōu)力在NHL自體造血干細(xì)胞移植中的應(yīng)用（-）Case2,20歲，男性，以左鎖骨上腫物起病診斷T淋巴母細(xì)胞淋巴瘤ⅣA

CHOP方案7周期后復(fù)發(fā)再次給予MTX+ARA-C;2周期VDLC化療并采集自體造血干細(xì)胞經(jīng)馬法蘭/米托蒽醌/諾維本/BCNU預(yù)處理行自體造血干細(xì)胞移植移植后+1津優(yōu)力促進(jìn)造血恢復(fù)移植后+12白細(xì)胞逐步恢復(fù)津優(yōu)力在NHL自體造血干細(xì)胞移植中的應(yīng)用（二）Case3,46歲，男性，以頸部腫物起病在安徽診斷非霍奇金淋巴瘤（外周T細(xì)胞，非特指型，ⅣB給予VIDL、EPOCH、VIDL、EPOCH、VIP方案化療，經(jīng)G-CSF采集自體造血干細(xì)胞6/kg，8/kg)經(jīng)BCNU/CTX/VP-16預(yù)行自體造血干細(xì)胞移植移植后+1津優(yōu)力促進(jìn)造血恢復(fù)移植后+16白細(xì)胞逐步恢復(fù)AdverseEventsAssociatedwith

MyeloidGrowthFactorsOverdoseofpegfilgrastim:casereport59years-oldmanwithastageIII-BperipheralTlymphomawithCD4expression.ChemotherapywasstartedwithCHOP-14combinedwithpegfilgrastimasprimaryprophylaxisAnerrorinthedispensingsystemmeantthatthepatientreceivedpegfilgrastimfor4consecutivedays.3daysafterthelastdoseofpegfilgrastim,thepatientremainedstable,withnoremarkablesymptomsorassociatedlaboratoryabnormalities

RiuG,etal，JOncolphampract2014

結(jié)論長(zhǎng)效G-CSF，動(dòng)員干細(xì)胞高效，簡(jiǎn)便長(zhǎng)效G-CSF可以代替G-CSF

動(dòng)員干細(xì)胞（病人，健康人）移植后應(yīng)用優(yōu)于G-CSF存在調(diào)節(jié)免疫耐受的可能，要在進(jìn)一步研究中證實(shí)內(nèi)容PEG-rhG-CSF動(dòng)員干細(xì)胞的意義自體移植后PEG-rhG-CSF應(yīng)用

PegylatedG-CSFVSG-CSF

動(dòng)員CD34+細(xì)胞的成分不盡相同ConclusionsStimulationwithpegylated-G-CSForG-CSFresultsindifferentexpressionofkeyregulatorygenesanddifferentfunctionalpropertiesofmobilizedhematopoieticstemcellsaswellastheirprogeny,afindingthatmightberelevantfortheapplicationofthesecellsinbloodstemcelltransplantation.PegylatedG-CSFVSG-CSF

動(dòng)員CD34+細(xì)胞的成分不盡相同BoneMarrowTransplant.2009May;43(9):669-77.

異基因移植：健康人動(dòng)員干細(xì)胞結(jié)論：安全可靠

異基因移植：健康人動(dòng)員干細(xì)胞

異基因移植：健康人動(dòng)員干細(xì)胞

PEGG-CSF,improvementof

G-CSFefficacyinmobilizationofhematopoieticstemcells.

PEGG-CSFhadasignificantlyimprovedefficacyinthemobilizationofhematopoieticstemcells(HSC).PEGG-CSFmayfunctionasaneffectiveandsafetoolforthemobilizationofHSCpriortobonemarrowtransplantation.PEGG-CSFmayserveasaplatformforthedeliveryofadditionalshort-half-lifeproteins/peptidesJControlRelease.2009Apr2;135(1):44-50.

DCEP+1次固定劑量pegylatedfilgrastim

可采集到足夠的外周血干細(xì)胞，多發(fā)性骨髓瘤

Transfusion.2008May;48(5):857-60CD34+cells采集量：5.72x10(6)/kg（）kg20例(87%)>2x10(6)27次采集PBSC1次采集成功：17/23,74%2次采集成功：5/23,26%中位采集時(shí)間：12days(11-16days).結(jié)果：promising

異基因移植：PEGG-CSF

一次12mg可以一次采集足夠造血干細(xì)胞

6mgpeg-G-CSF動(dòng)員：peakCD34+：29+/-5/microL.4days后采集：2.7+/-.4x10(6)所以供者需2次采集4.2+/-.5x10(6)12mg,PEG-G-CSFpeakCD34+:99+/-11/microL12/13donors:一次采集成功apheresis：8.9+/-1.4x10(6)BiolBloodMarrowTransplant.

2006Jun;12(6):603-7.

成功的干細(xì)胞動(dòng)員和移植

pegG-CSFvsG-CSF,多發(fā)性骨髓瘤.

BoneMarrowTransplant.2005Jan;35(1):33-6.動(dòng)員方案：4g/m(2)CTX12mgPEGG-CSFG-CSF(8.5ug/kg)n=12N=12leukocyterecovery1214CD34+cellpeak1215CD34+cellpeak78111/mulAHSCT:melphalan(200mg/m(2))100daysposttransplantSummary:單次pegfilgrastim聯(lián)合化療可動(dòng)員足夠的CD34+細(xì)胞！R-ESHAP+長(zhǎng)效GCSF:

DLBCL干細(xì)胞動(dòng)員R-ESHAP+長(zhǎng)效GCSF:

DLBCL干細(xì)胞動(dòng)員R-ESHAP+長(zhǎng)效GCSF:

DLBCL干細(xì)胞動(dòng)員R-ESHAP+長(zhǎng)效GCSF:

DLBCL干細(xì)胞動(dòng)員干細(xì)胞動(dòng)員：G-CSFVS

長(zhǎng)效