Mobilisierung hämatopoietischer Stammzellen

Zusammenfassung

Als Stammzellmobilisierung wird der pharmakologisch induzierte Egress hämatopoietischer Stammzellen aus dem Knochenmark in das Peripherblut bezeichnet. Die klinische Bedeutung der Stammzellmobilisierung liegt darin, dass mobilisierte Stammzellen mittels Leukapherese aus dem Blut extrahiert und als Transplantat für entsprechend konditionierte Patienten verwendet werden können. Heute werden fast alle autologen und ca. 80 % der allogenen Transplantationen mit „mobilisierten Stammzellen“ durchgeführt. Obwohl eine Vielzahl Stammzellen mobilisierender Substanzen bekannt ist, haben bisher lediglich das myelopoietische Zytokin Granulozytenkolonien stimulierender Faktor (G-CSF) und, bei schlecht mobilisierenden Patienten, der CXCR4-Antagonist Plerixafor klinische Bedeutung erlangt. Durch die Aufnahme der Stammzellherstellung in das Arzneimittelgesetz ist vielen Ortes die Verantwortung für die Herstellung von Stammzellpräparaten und damit auch für die Stammzellmobilisierung an die Transfusionsmedizin übergegangen. Dieses fokussierte Review skizziert den Stand des Wissens zu Mechanismen der Stammzellmobilisierung speziell bezüglich der heute in der Klinik eingesetzten Agenzien und fasst die klinischen Erfahrungen und arzneimittelrechtlichen Aspekte der klinischen Stammzellmobilisierung zusammen.

Abstract

The term stem cell mobilization describes the pharmacologically enforced egress of hematopoietic stem cells from bone marrow into the peripheral blood. The clinical interest in stem cell mobilization originates from the possibility of extraction of mobilized stem cells from blood by leukoapheresis, for the purpose of transplantation in appropriately conditioned recipients. Thus today virtually all autologous and 80 % of allogeneic stem cell transplants use mobilized blood-derived stem cells as the transplant source. Despite the plethora of recognized mobilizing agents, thus far only the myelopoietic cytokine granulocyte-colony stimulating factor (G-CSF) and, for poorly mobilizing patients, the CXCR4 antagonist Plerixafor have achieved clinical relevance. Since the time that stem cell preparations were brought under the umbrella of the German Medicines Act, many transfusion services have assumed the responsibility for stem cell product manufacturing and consequently also for stem cell mobilization. This focussed review sketches our current understanding of the basic science surrounding molecular mechanisms of stem cell mobilization specifically pertaining to currently used clinical mobilizing agents and summarizes clinical experience and regulatory aspects of clinical stem cell mobilization.

Schlüsselwörter

G-CSF - Plerixafor - Stammzellmobilisierung - human - klinisch - Spender - allogen - autolog - Stammzellnische

Key words

G-CSF - Plerixafor - stem cell mobilization - human - clinical - normal donor - allogeneic - autologous - stem cell niche

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