혈액종양질환 환자에서 자가말초혈액 조혈모세포이식 시 가동화
Mobilization of Peripheral Blood Stem Cells for Autologous Transplantation in Patients with Hematologic Malignancies
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배경: 자가말초혈액조혈모세포이식은 전신마취, 수술적 접근, 장기기간의 입원 등이 필요하지 않은 많은 장점을 가진 치료방법으로 알려짐에도 불구하고 악성혈액질환 환자들의 상태가 말초조혈모세포 채집산물에 어떠한 영향을 미치는가에 대해서는 아직 논란이 존재한다. 따라서 본 연구를 통하여 저자들은 악성혈액질환 환자들의 진단명, 성별 및 나이가 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수에 어떠한 영향을 미치는가에 대하여 알아보고자 하였다. 방법: 2008년부터 2011년까지 대구가톨릭대학병원에서 자가말초혈액조혈모세포이식술을 시행 받은 30명의 악성혈액질환 환자를 대상으로 연구를 시행하였다. 악성혈액질환에는 급성림프구성백혈병(acute lymphoid leukemia, ALL) 환자 2명, 급성골수구성백혈병(acute myeloid leukemia, AML) 환자 8명, 미만성큰B세포림프종(diffuse large B-cell lymphoma, DLBL) 환자 11명, 다발골수종 (multiple myeloma, MM) 환자 6명과 T세포림프종(T-cell lymphoma) 환자 3명이 포함되었다. 결과: 말초혈액조혈모세포채집술을 시행한 결과 MM 환자들이 가장 높은 평균 단핵세포 수(2.07±0.67×108 cells/kg)와 CD34양성세포 수(1.28±0.58×106 cells/kg)를 나타내었고, T cell lymphoma 환자들이 가장 낮은 평균단핵세포 수(1.23±0.49×108 cells/kg)와 CD34양성세포 수(0.20±0.6×106 cells/kg)를 나타내었다. 남성 환자들이 여성 환자들에 비하여 높은 평균단핵세포 수(1.71±0.76×108 cells/kg)와 CD34양성세포 수(0.96±1.38×106 cells/kg)를 나타내었다. 44세 이하 환자군에서 44세 이상 환자군에 비하여 높은 평균 CD34양성세포 수(0.96±1.37×106 cells/kg)를 나타내었으나 낮은 평균의 단핵세포 수(1.49±0.74×108 cells/kg)를 나타내었다. 결론: 본 연구를 통하여 악성혈액질환 환자들의 진단명, 성별 및 나이별에 따라 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수가 차이가 있음을 확인할 수 있었다. 그러나 통계적으로 유의한 차이를 보이는 유일한 항목은 진단에 따른 단핵세포 수로 분석되었다(P<0.05).
Abstract
Background: Autologous peripheral blood-stem cell transplantation (autoPBSCT) is the treatment of choice for hematologic malignancy, because the technique requires neither general anesthesia nor surgical intervention, amongst many other advantages. Despite these benefits, the risk of hematologic malignancy, as well as the effect of patient age and sex on the prediction of successful collection of autoPBSCT are still unclear. The purpose of this study was to examine whether the hematologic diagnosis of the disease, and age or sex affect the mobilization of CD34+ cells and mononuclear cells. Methods: We retrospectively investigated 30 (6 multiple myeloma, 11 diffuse large B-cell lymphoma, 8 acute myeloid leukemia, 2 acute lymphoid leukemia, and 3 T-cell lymphoma) patients who underwent autoPBSCT between 2008 and 2011 at Daegu Catholic University Hospital. Results: Patients with multiple myeloma had the highest average of both mononuclear cell (MNC) (2.07±0.67×108 cells/kg) and CD34+ cell (1.28±0.58×106 cells/kg) counts. Patients with T-cell lymphoma had both the lowest MNC (1.23±0.49×108 cells/kg) and CD34+ cell (0.20±0.6×106 cells/kg) counts. Male patients showed greater collected CD34+ cell counts (0.96±1.38×106 cells/kg) and MNC counts (1.71±0.76×108 cells/kg) than the female patients. Patients under the age of 44 had higher collected CD34+ cell counts (0.96±1.37×106 cells/kg) but lower counts of MNC (1.49±0.74×108 cells/kg). Conclusions: The collected MNC and CD34+ cell counts varied between the types of malignancies, and with respect to sex and age. However, only collected MNC counts were significantly different (P<0.05) among the different types of malignancies.
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