Assouline Sarit, Sylvestre Marie-Pierre, Carriere Philippe, Shustik Chaim, Laneuville Pierre
Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Transfusion. 2006 Feb;46(2):174-9. doi: 10.1111/j.1537-2995.2006.00695.x.
Peripheral blood progenitor cells (PBPCs) are often collected after mobilization with high-dose cyclophosphamide (HDC) combined with growth factors. HDC may not be needed for PBPC mobilization, and patients with lymphoid malignancies can be harvested with treatment regimens of chemotherapy.
A retrospective analysis was performed on 141 patients with lymphoma or multiple myeloma whose PBPCs were harvested after chemotherapy. The PBPC yield and time to mobilization was compared between patients who received HDC (n = 51) and other chemotherapy regimens (n = 90) including high-dose cyclophosphamide and etoposide (HDC plus VP-16; n = 41), CHOP, ESHAP, ABVD, VAD, and others (n = 49). A multiple linear regression model and proportional hazards model determined factors influencing yield and time to mobilization, respectively.
The difference in mean yield between HDC and all non-HDC regimens was significant, with HDC plus VP-16 resulting in the highest yields. The proportion of patients achieving a CD34 count in excess of 5 x 10(6) per kg did not differ significantly between the regimens. In a multiple linear regression model, HDC plus VP-16 resulted in a higher PBPC yield than HDC but all other regimens did not. In addition, patients exposed to more than one prior chemotherapy regimen had lower yield regardless of the mobilization regimen. The mean number of days to mobilization with HDC was 10.2 days, 17.1 days for HDC plus VP-16, and 14.2 days for all other regimens. The timing of mobilization was influenced by the chemotherapy used and the number of prior regimens in a proportional hazards model.
These results demonstrate a higher mean yield of PBPCs with HDC plus VP-16 but no difference in yield between non-HDC plus VP-16 regimens used for first-line or relapse therapy and HDC, suggesting that HDC may be an unnecessary additional therapy.
外周血祖细胞（PBPCs）通常在大剂量环磷酰胺（HDC）联合生长因子动员后采集。PBPC动员可能不需要HDC，淋巴瘤患者可通过化疗方案进行采集。
对141例化疗后采集PBPCs的淋巴瘤或多发性骨髓瘤患者进行回顾性分析。比较接受HDC（n = 51）和其他化疗方案（n = 90）患者的PBPC产量和动员时间，其他化疗方案包括大剂量环磷酰胺和依托泊苷（HDC加VP - 16；n = 41）、CHOP、ESHAP、ABVD、VAD等（n = 49）。多元线性回归模型和比例风险模型分别确定影响产量和动员时间的因素。
HDC与所有非HDC方案的平均产量差异显著，HDC加VP - 16产量最高。各方案中CD34计数超过每千克5×10⁶的患者比例无显著差异。在多元线性回归模型中，HDC加VP - 16的PBPC产量高于HDC，但其他所有方案均无此效果。此外，无论动员方案如何，接受过一种以上既往化疗方案的患者产量较低。HDC动员的平均天数为10.2天，HDC加VP - 16为17.1天，其他所有方案为14.2天。在比例风险模型中，动员时间受所用化疗和既往方案数量的影响。
这些结果表明，HDC加VP - 16的PBPC平均产量较高，但用于一线或复发治疗的非HDC加VP - 16方案与HDC之间的产量无差异，提示HDC可能是不必要的额外治疗。
