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G-CSF로 투여받은 정상공혈자로부터 원심분리기와 적혈구침강촉진제를 이용한 효과적인 백혈구수집의 임상경험
박성규,한치화,김동욱,이종욱,김상돌,송차숙,최정현,민우성,신완식,김춘추,김원일,김동집 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1
In recent days, the granulocyte transfusion is re-emerging because several investigators reported the effectiveness of large granulocytes (mord than 2×10^(10)per day) to control life-threatening infections for severe neutropenic patients. Application of continuous cell separators as well as erythrocyte sedimentation enhancing agents (hydroxyethylstarch, HES) made it possible to collect enough therapeutic number of granulocytes from a single donor. To increase the efficiency of granulocyte collection we gave G-CSF to normal donors at least 12 hours before harvest. Also, 10% pentastarch solution (low molecular weight-HES) which has minimal side effects compared with 6% hetastarch (high molecular weight-HES) was used to enhance erythrocyte sedimentation during centrifugation. We measured the vitro effect of HESs on the erythrocyte sedimentation rate (ESR) of peripheral whole blood depending their concentrations; the ESR (mm/hr) of 10% PS was significantly higher than that of 6% PS or HS(39.19±11.52 vs 11.62±7.26 or 15.23±6.86, p< 0.01) and that of PBS (5.17±2.85, p< 0.01). We compared the efficiency of granulocyte collection between G-CSF treated (n=9) and untreated (n=30) donors: the total number of granulocytes in the latter cases ranged 0.2 to 1.7×10^(10) (median 2.9×10^(10)) (p<0.01). Of interest, the peripheral WBC counts of donors when the counts were over 10,000/mm³ on the day of collection, correlated with the yield of granulocytes in the final products (r=0.75). Except one donors who had peripheral WBC count more than 10,000/mm³ without G-CSF, all cases showing peripheral WBC count over 10,000/mm³ had received G-CSF before collection. Furthermore, the WBC kinetics in G-CSF trealed donors showed that the peripheral WBC counts rose over 10,000/mm³ quickly (within 12 hours) and sustained during the period of injection. Among three neutropenic patients who had been received large dose grannlocgtes daily due to definitive critical infection, two patients (one in induction for ALL, and the other in early recovery phase of allogeneic BMT for severe aplastic anernia) recovered completely. However one who firstly diagnosed as SAA showed only temporary responses during granulocyte transfusion. Therefore, we suggest that (1) collection of large dose of granulocytes using a continuous cell separator with 10% PS is possible from a donor when pretreated by G-CSF, (2) such therapeutic granulocyte transfusion is effective to control life-threatening infections of severe neutropenic patients whose granulocyte counts are expected to recover within several days.
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