Stockerl-Goldstein K E, Reddy S A, Horning S F, Blume K G, Chao N F, Hu W W, Johnston L F, Long G D, Strober S, Wong R M, Feiner R H, Kobler S, Negrin R S
Divisions of Bone Marrow Transplantation, Stanford University School of Medicine, California 94305-5623, USA.
Biol Blood Marrow Transplant. 2000;6(5):506-12. doi: 10.1016/s1083-8791(00)70021-8.
Our purpose was to evaluate the outcome and costs of high-dose chemotherapy and autologous peripheral blood progenitor cell (PBPC) transplantation in patients with the inability to mobilize sufficient numbers of PBPCs to allow rapid engraftment after PBPC transplantation. We treated 172 consecutive non-Hodgkin's lymphoma (NHL) patients with cyclophosphamide and granulocyte colony-stimulating factor followed by apheresis to collect PBPCs. The cells were separated on a Percoll gradient and purged with monoclonal antibodies and complement. The patients were categorized as "good" mobilizers if a collection of > or =2 x 10(6) CD34+ cells/kg was obtained (n = 138, 80%) or "poor" mobilizers if <2 x 10(6) CD34+ cells/kg were obtained (n = 34, 20%). With a median follow-up of 3.5 years, there is no statistically significant difference in actuarial event-free survival, overall survival, or relapse for good mobilizers compared with poor mobilizers. However, there was a trend toward increasing nonrelapse, transplantation-related mortality of 11.8% for poor mobilizers versus 3.6% for good mobilizers (P = .08) and early death from all causes including relapse within 120 days (poor 20.6% versus good 8.7%, P = .06). The total cost for bone marrow transplantation-related care was significantly higher, at $140,264 for poor mobilizers versus $80,833 for good mobilizers (P = .0001). The population of patients with NHL who mobilize PBPCs poorly into the circulation have a higher cost for posttransplant support. However, there is no significant difference in relapse, event-free survival, or overall survival for such patients compared with those who mobilize PBPCs easily.
我们的目的是评估高剂量化疗及自体外周血祖细胞（PBPC）移植用于那些无法动员足够数量的PBPC以实现PBPC移植后快速植入的患者的疗效及成本。我们连续治疗了172例非霍奇金淋巴瘤（NHL）患者，先给予环磷酰胺和粒细胞集落刺激因子，随后进行单采以收集PBPC。细胞在Percoll梯度上分离，并用单克隆抗体和补体清除。如果收集到≥2×10⁶个CD34⁺细胞/千克，则将患者归类为“良好”动员者（n = 138，80%）；如果收集到的CD34⁺细胞/千克＜2×10⁶，则归类为“不良”动员者（n = 34，20%）。中位随访3.5年，良好动员者与不良动员者在精算无事件生存率、总生存率或复发率方面无统计学显著差异。然而，不良动员者的非复发、移植相关死亡率有上升趋势，分别为11.8%和3.6%（P = 0.08），且包括120天内复发在内的所有原因导致的早期死亡率不良动员者为20.6%，良好动员者为8.7%（P = 0.06）。骨髓移植相关护理的总成本显著更高，不良动员者为140,264美元，良好动员者为80,833美元（P = 0.0001）。将PBPC动员到循环中的能力较差的NHL患者群体在移植后支持方面成本更高。然而，与那些容易动员PBPC的患者相比，这类患者在复发、无事件生存率或总生存率方面无显著差异。
