右旋糖酐+DMSO用于脐血回输人体有没有影响?

冠忠

各位师兄，我看到有很多人用DMSO+Dextran40来储存脐血和骨髓，如果骨髓回输不做DMSO+Dextran40清洗，用于成人，对人体有害吗?谢谢

ciweiyuan

同问，据我查到的资料显示肯定是要清洗的，dmso对人体是有害的，现在国际上有如下常用标准：The maximum tolerated dose of DMSO has not been established, but it is customary not to exceed a DMSO dose of 1 gm/kg/day when given intravenously.

s02260441

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: V- d% _2 B' S在HEMACORD的仿单中亦有提及DMSO的静脉注射容许量：+ o  C9 E0 s0 o' N

/ [6 e: i8 E6 H0 M- Q$ m- eThe recommended limit on DMSO administration is 1 gram per kg body weight per day.4 z# ^; b; k' w' L# k* I* S
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但在HEMACORD解冻使用的操作步骤同样包含移除抗冻剂的流程，仍然是为了注射安全性考量，避免患者有不良反应发生，建议还是将DMSO清洗掉。) \' H" Y1 i% b. [& x4 J( V
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冠忠

Dextran40有害?

细胞海洋

回复 冠忠 的帖子
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你回复谁 就点击对方回复帖子中的回复按钮 然后输入内容 像我这样3 _) o0 W) `: ~
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否则他会看不到

s02260441

回复 冠忠 的帖子8 d7 P4 g  B$ }' }

/ }9 H. P  D& T2 C4 O8 X+ B9 b有疑虑的是抗冻剂DMSO，过量进入人体会有发生不良反应的可能。0 G# S8 X) x+ @! p' T: E  Q" {$ d
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DEXTRAN 40一般用做血浆的替代品，可直接注射至人体的，关注点不会是它。

冠忠

回复 s02260441 的帖子$ I; q2 g2 F7 p9 h1 ^( X0 C8 \+ k
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Published in final edited form as:9 Q" D9 ?5 m1 g6 ^" i0 r
Biol Blood Marrow Transplant. 2009 December ; 15(12): 1596–1602. doi:10.1016/j.bbmt.2009.08.009.
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9 ^$ O; {" x6 mA “No-wash” Albumin-Dextran Dilution Strategy for Cord Blood' ^: P# G; X& T! w8 S! ]
Unit Thaw: High Rate of Engraftment and a Low Incidence of+ y. W3 L- g- b  O6 U+ W8 q
Serious Infusion Reactions
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Abstract
4 Z4 M* R! r+ O( \/ Y, VPreparation of cord blood (CB) units for infusion by albumin-dextran dilution without8 J& U/ }, U: i0 c  a% M( ^) J
centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside; N9 j+ v0 _  t+ X# f
thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB5 l1 Z. o: P, u; z
transplantation (CBT) using this technique in 54 consecutive CBT recipients ≥20 kg. Patients* B4 M9 {3 u1 H3 r3 U7 ^5 U
[median age 42 years (range 7–66); median weight 71 kg (range 24–109)] were transplanted for
) Z! Z: P) T3 ]+ D+ Lhigh-risk hematological malignancies with ablative (n=35) or non-ablative (n=19) conditioning
4 {+ R$ g0 J; f6 U' zand 4–6/6 human leukocyte antigen (HLA)-matched double unit grafts. One hundred and seven
* U, d' ]; |: e; Z; aunits were thawed with dilution whereas 1 red blood cell (RBC) replete unit was washed. A 5:1
& Y/ ?& X+ D+ x) t4 ~( tdextran 40/ 25% albumin solution was used. RBC depleted units (n=104) were diluted ≥5.5 fold
6 Z- C2 `- s6 w5 Z[median final volume 200 ml (range 200–500)] whereas RBC replete units (n=3) were diluted ≥4
. \" h. z  S, Q! Hfold [median final volume 400 ml (range 400–535)]. Total nucleated cell (TNC) recovery was
# S' T# r- s; |86%; the median infused TNC dose was 2.17 × 107/kg/unit. While 35 patients (65%) had a total of; t" p2 Z6 u( y! `+ g, n
45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2
5 K: p2 T) x4 \* J, p9 T+ Drenal impairment) requiring additional therapy, there were no infusion-related serious adverse
  p: N0 M, j; L+ M$ h  Zevents, and reactions were not related to DMSO dose/kg. Cumulative incidence of sustained donor; O' y0 o9 [3 i: h8 n
engraftment was 94% (95%CI: 87–100) with neutrophil recovery occurring at a median of 25 days
+ b# I$ B9 p3 q2 d) W9 R  {8 i(range 13–43) in ablative and 10 days (range 7–36) in non-myeloablative recipients. CB thaw with- C6 J! X8 K$ s1 Q6 L6 R/ i* i
albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to
7 b# _, M# x0 @4 r+ I* S+ {infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained
' `! K2 O  n. ~/ oengraftment in CBT recipients ≥20 kg.
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s02260441

回复 冠忠 的帖子
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在您提供的摘要中提到" there were no infusion-related serious adverse events, and reactions were not related to DMSO dose/kg."
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: K, {! ~. ^* X, X- `. m9 h0 M试验结果是没有问题的，当然我前篇回文也提到有安全疑虑的是DMSO的浓度，因此是否要清洗的最终决定也许可交由临床医师做判断，在细胞回收率与注射安全两方面做综合考量。% W/ F2 b% y% o4 B/ D

& z( I9 D) R" Q4 U  n* ]& m8 V不过值得注意的是，我在3F中附上的HEMACORD是去年4月美国FDA核准上市的脐血干细胞药物，在其仿单中仍存在解冻後清洗脐血的步骤，因此我想目前的大方向还是在解冻後需清洗移除抗冻液的这个方式吧！

冠忠

回复 s02260441 的帖子
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0 [( W* G+ x) Z2 q* Z清洗困難?

s02260441

回复 冠忠 的帖子2 F$ N) U2 T6 k9 u

4 z( }' ^! F8 M4 H. O# p6 l清洗并不困难，有许多Protocol可以参考，包括我前面附上的HEMACORD说明中也有。