Mollee P, Pereira D, Nagy T, Song K, Saragosa R, Keating A, Crump M
University of Toronto Autologous Blood and Marrow Transplant Service, Princess Margaret Hospital, Toronto, Canada.
Bone Marrow Transplant. 2002 Sep;30(5):273-8. doi: 10.1038/sj.bmt.1703653.
We aimed to assess the effectiveness of cyclophosphamide, etoposide and G-CSF (C+E) to mobilize peripheral blood stem cells for autologous stem cell transplantation in patients with lymphoma. A matched cohort study was performed comparing patients mobilized with C+E to patients mobilized with cyclophosphamide and G-CSF (C alone). Patients were matched for disease, prior radiotherapy and a chemotherapy score reflecting the amount and type of prior chemotherapy. Thirty-eight consecutive patients mobilized with C+E were compared with 38 matched controls. C+E was equivalent to C alone in terms of numbers of patients achieving a minimum threshold of > or =2 x 10(6)/kg CD34(+)cells (82% vs 79%, P = 0.74). C+E was superior, however, in terms of total CD34(+) yield (6.35 vs 3.3 x 10(6)/kg, P < 0.01), achieving a target graft of > or =5 x 10(6)/kg (55% vs 34%, P = 0.04) and obtaining both a minimum (61% vs 32%, P < 0.01) and target (45% vs 13%, P < 0.01) graft in one apheresis. This superiority was largely confined to patients with lower chemotherapy scores. There was no difference in neutrophil and platelet recovery or transfusion requirements for those who subsequently received high-dose therapy and stem cell transplantation. Thus, C+E improves the efficiency of peripheral blood stem cell collection, but does not increase the number of patients who can proceed to transplantation. Most of the benefit of the regimen was confined to patients who had not received extensive prior therapy. Novel strategies are required to increase the collection efficiency of 'hard to mobilize' patients.
我们旨在评估环磷酰胺、依托泊苷和粒细胞集落刺激因子（C+E）动员外周血干细胞用于淋巴瘤患者自体干细胞移植的有效性。进行了一项匹配队列研究，将接受C+E动员的患者与接受环磷酰胺和粒细胞集落刺激因子（仅C）动员的患者进行比较。患者在疾病、既往放疗以及反映既往化疗量和类型的化疗评分方面进行匹配。将连续38例接受C+E动员的患者与38例匹配对照进行比较。在达到≥2×10⁶/kg CD34⁺细胞最低阈值的患者数量方面，C+E与仅C相当（82%对79%，P = 0.74）。然而，在总CD34⁺产量方面，C+E更具优势（6.35对3.3×10⁶/kg，P < 0.01），达到≥5×10⁶/kg目标移植物的比例更高（55%对34%，P = 0.04），并且在一次单采中获得最低（61%对32%，P < 0.01）和目标（45%对13%，P < 0.01）移植物的比例更高。这种优势主要局限于化疗评分较低的患者。对于随后接受高剂量治疗和干细胞移植的患者，中性粒细胞和血小板恢复情况或输血需求没有差异。因此，C+E提高了外周血干细胞采集效率，但并未增加能够进行移植的患者数量。该方案的大部分益处局限于未接受过广泛既往治疗的患者。需要新的策略来提高“难以动员”患者的采集效率。
