Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC 29425-6350, USA.
Bone Marrow Transplant. 2011 Apr;46(4):523-8. doi: 10.1038/bmt.2010.170. Epub 2010 Jul 12.
The ideal method to mobilize autologous hematopoietic stem cells (AHSCs) in patients with lymphoma or multiple myeloma remains to be determined. The use of plerixafor, added to growth factor, may overcome the limitations to the use of growth factor mobilization without chemotherapy. We developed and validated a cost-based decision-making algorithm that uses the CD34+ cell count in the peripheral blood on the fourth day of G-CSF administration and the target CD34+ cell count for the specific patient to decide on the use of plerixafor (MUSC algorithm). We compared this approach (MA cohort) with a historical cohort of patients undergoing mobilization with CY 2000 mg/m(2) followed by G-CSF and GM-CSF (CY cohort). Fifty individuals are included in the MA cohort and 81 in the CY cohort. The mobilization failure rate was 2% in the MA cohort vs 22% in the CY cohort (P=0.01). Fewer patients in the MA cohort than in the CY cohort had infectious complications during mobilization requiring hospitalization (2 vs 30% P<0.01). There was significant shortening in the median number of days between starting mobilization and undergoing transplantation in the MA cohort (14 vs 43 days, P<0.01). In conclusion, growth factor and patient-adapted use of plerixafor provides safer hematopoietic stem cell mobilization and faster access to AHSC transplantation.
在淋巴瘤或多发性骨髓瘤患者中动员自体造血干细胞 (AHSCs) 的理想方法仍有待确定。添加培洛昔福的生长因子的使用可能会克服不使用化疗进行生长因子动员的限制。我们开发并验证了一种基于成本的决策算法，该算法使用 G-CSF 给药第 4 天外周血中的 CD34+细胞计数和特定患者的目标 CD34+细胞计数来决定是否使用培洛昔福（MUSC 算法）。我们将这种方法（MA 队列）与接受 CY 2000mg/m²后进行 G-CSF 和 GM-CSF 动员的历史队列患者（CY 队列）进行了比较。MA 队列中包括 50 名个体，CY 队列中包括 81 名个体。MA 队列的动员失败率为 2%，而 CY 队列为 22%（P=0.01）。MA 队列中需要住院治疗的动员期间感染并发症的患者少于 CY 队列（2%比 30%，P<0.01）。MA 队列中从开始动员到接受移植的中位天数明显缩短（14 天比 43 天，P<0.01）。总之，生长因子和患者适应性使用培洛昔福可提供更安全的造血干细胞动员，并更快地进行 AHSC 移植。
