Nakasone Hideki, Kanda Yoshinobu, Ueda Tomoki, Matsumoto Kenji, Shimizu Naomi, Minami Jiro, Sakai Rika, Hagihara Maki, Yokota Akira, Oshima Kumi, Tsukada Yuiko, Tachibana Takayoshi, Nakaseko Chiaki, Fujisawa Shin, Yano Shingo, Fujita Hiroyuki, Takahashi Satoshi, Kanamori Heiwa, Okamoto Shinichiro
Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Saitama, Japan.
Am J Hematol. 2009 Dec;84(12):809-14. doi: 10.1002/ajh.21552.
The combination of cyclophosphamide and granulocyte-colony stimulating factor (G-CSF) has widely been used to mobilize hematopoietic stem cells (HSCs) for autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Recently, however, alternative approaches such as G-CSF alone or etoposide followed by G-CSF have been investigated. We, therefore, retrospectively analyzed the effects of these mobilization methods on collection yield and disease outcome in ASCT for MM. We reviewed 146 MM patients from whom we intended to collect stem cells. For mobilization, 67, 58, and 21 patients received cyclophosphamide and G-CSF, etoposide and G-CSF, and G-CSF alone (including nonmyelosuppressive chemotherapy followed by G-CSF), respectively. Among them, 136 achieved the target number of HSCs (at least 2 x 10(6)/kg). Lower creatinine and higher albumin levels at diagnosis were significantly associated with successful yield. A lower number of infused HSCs, use of the etoposide for mobilization and high ISS were associated with delayed hematopoietic recovery. The mobilization methods did not significantly affect either the successful collection of more than 2 x 10(6) CD34-positive cells/kg or PFS after ASCT. G-CSF alone was sufficient for stem cell mobilization for a single ASCT. The optimal approach to collect HSCs in MM remains to be elucidated.
环磷酰胺与粒细胞集落刺激因子（G-CSF）联合应用已广泛用于动员造血干细胞（HSC），以进行多发性骨髓瘤（MM）的自体干细胞移植（ASCT）。然而，最近人们对单独使用G-CSF或依托泊苷后再使用G-CSF等替代方法进行了研究。因此，我们回顾性分析了这些动员方法对MM患者ASCT中干细胞采集量和疾病转归的影响。我们回顾了146例计划采集干细胞的MM患者。在动员方面，分别有67例、58例和21例患者接受了环磷酰胺与G-CSF联合、依托泊苷与G-CSF联合以及单独使用G-CSF（包括非骨髓抑制性化疗后使用G-CSF）。其中，136例达到了造血干细胞的目标数量（至少2×10⁶/kg）。诊断时较低的肌酐水平和较高的白蛋白水平与采集成功显著相关。输注的造血干细胞数量较少、使用依托泊苷进行动员以及国际分期系统（ISS）较高与造血恢复延迟相关。这些动员方法对成功采集超过2×10⁶个CD34⁺细胞/kg或ASCT后的无进展生存期（PFS）均无显著影响。单独使用G-CSF足以进行单次ASCT的干细胞动员。MM中采集造血干细胞的最佳方法仍有待阐明。
