Lerro K A, Medoff E, Wu Y, Seropian S E, Snyder E, Krause D, Cooper D L
Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
Bone Marrow Transplant. 2003 Dec;32(12):1113-7. doi: 10.1038/sj.bmt.1704286.
High-dose chemotherapy and autologous stem cell rescue is considered a standard part of initial therapy for patients with multiple myeloma. Therefore, potential transplant candidates are generally treated with dexamethasone-based programs rather than alkylating agents to avoid stem cell toxicity. The optimal mobilizing regimen for patients with multiple myeloma has not been defined. However, aggressive chemotherapy may result in excessive morbidity and cost in this older, immunocompromised population. We retrospectively examined our experience with a well-tolerated regimen of 1.5 g/m(2) cyclophosphamide on day -10 followed by 10 microg/kg G-CSF beginning on day -7 in 50 consecutive patients with multiple myeloma and no prior alkylating agent therapy. Median stem cell collection was 4.88 x 10(6) CD34+ cells/kg per apheresis and 44 patients collected >5 x 10(6) CD34+ cells/kg within 2 days. In 36 patients, more than 10 x 10(6) CD34+ cells/kg were collected including 33 patients who required 1-2 days of collection. One patient required hospitalization for fever/neutropenia and two required weekend apheresis. We conclude that 1.5 g/m(2) cyclophosphamide plus 10 microg/kg G-CSF is a safe, effective, highly predictable mobilizing program that uniformly provided enough stem cells for one transplant and enough stem cells for two transplants.
大剂量化疗和自体干细胞救援被认为是多发性骨髓瘤患者初始治疗的标准组成部分。因此，潜在的移植候选者通常采用以地塞米松为基础的方案进行治疗，而非烷化剂，以避免干细胞毒性。多发性骨髓瘤患者的最佳动员方案尚未确定。然而，在这个年龄较大、免疫功能低下的人群中，积极的化疗可能会导致过高的发病率和成本。我们回顾性研究了我们对50例连续的多发性骨髓瘤患者（之前未接受过烷化剂治疗）采用的一种耐受性良好的方案的经验，该方案为在第-10天给予1.5 g/m(2)环磷酰胺，随后从第-7天开始给予10 μg/kg粒细胞集落刺激因子（G-CSF）。每次单采的中位干细胞采集量为4.88×10(6)个CD34+细胞/kg，44例患者在2天内采集到>5×10(6)个CD34+细胞/kg。在36例患者中，采集到超过10×10(6)个CD34+细胞/kg，其中33例患者需要1-2天的采集时间。1例患者因发热/中性粒细胞减少需要住院治疗，2例患者需要在周末进行单采。我们得出结论，1.5 g/m(2)环磷酰胺加10 μg/kg G-CSF是一种安全、有效、高度可预测的动员方案，能一致地提供足够进行一次移植的干细胞以及足够进行两次移植的干细胞。
