原発性ALアミロイドーシスにおける末梢血幹細胞採取の安全性と効率の検討

目的:当施設での自己末梢血幹細胞移植に際しての末梢血幹細胞採取時の安全性と効率について検討した.対象と方法:過去5年間にALアミロイドーシス(AL群:8例)と多発性骨髄腫(MM群:6例)に対し自己末梢血幹細胞移植を行った患者を対象とした.方法は遠心式血液成分分離装置を用いて,血流量50mL/min,その1/15の流量でACD-A液を投与し総量10Lとなるまで分離を行った.検討項目は,施行時の血圧と採取血液中のCD34陽性細胞数とした.結果:AL群で開始30分に有意に血圧が低下した.採取血液中のCD34陽性細胞数はAL群ではMM群に比べ有意に高かった.結語:ALアミロイドーシスは臓器障害の合併から末梢血幹細胞採取で血圧低下が生じる可能性があり,慎重な体外循環が要求される.ALアミロイドーシスでは幹細胞採取率が高く,体外循環時間を減らすことができ,より安全に治療にも反映できると考えられる.
Objective: This study was conducted to clarify the safety and the efficiency of peripheral blood stem cell harvest (PBSCH) for treatment of autologous peripheral blood stem cell transplantation (auto-PBSCT). Patients and methods: Patients who received auto-PBSCT due to AL amyloidosis (AL group: n=8) and multiple myeloma (MM group: n=6) in the past five years were eligible for this study. Apheresis of mononuclear cells containing a CD34 positive fraction was performed using a cell separator via pretreated peripheral blood. For cell separation, blood flow was 50mL/min and a 1/15 blood volume of ACD-A solution was used as an anticoagulant. Ten liters of blood was circulated for harvest. Monitoring of blood pressure was performed and yield rate of CD34-positive mononuclear cells was determined during PBSCH. Results: Blood pressure at 30min after starting PBSCH was significantly decreased in the AL group. The yield rate of CD34-positive cells in the AL group was significantly higher than that in the MM group. Conclusions: Careful extracorporeal circulation is required in AL amyloidosis because potential hypotension can occur during PBSCH. Higher efficiency of CD34-positive cell harvest in AL amyloidosis can decrease the duration of extracorporeal circulation, resulting in reduction in PBSCH-related risk.

収集根拠 : NII-ELS
資料形態 : テキストデータ
コレクション : 国立国会図書館デジタルコレクション > 電子書籍・電子雑誌 > 学術機関 > 学協会
著者所属: 札幌医科大学附属病院臨床工学部
著者所属: 札幌医科大学医学部内科学第一講座
著者所属: 札幌医科大学医学部救急・集中治療医学講座
Affiliation: Division of Clinical Engineering, Sapporo Medical University Hospital
Affiliation: First Department of Internal Medicine, Sapporo Medical University School of Medicine
Affiliation: Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine