Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA.
Ann Pharmacother. 2010 Dec;44(12):2028-30. doi: 10.1345/aph.1P223. Epub 2010 Nov 23.
To report on the use of plerixafor in a patient with multiple myeloma and dialysis-dependent renal failure.
A 38-year-old man with multiple myeloma and dialysis-dependent renal failure was evaluated for stem cell transplantation. Stem cell mobilization with 6 doses of granulocyte colony-stimulating factor (G-CSF) 10 μg/kg/day yielded an inadequate maximum pre-apheresis CD34+ count of 5.6 cells/μL. The patient was treated with a postdialysis subcutaneous dose of plerixafor 160 μg/kg after 4 days of G-CSF therapy. After a single dose of plerixafor, the patient's pre-apheresis CD34+ count was 125.6 cells/μL. After 1 apheresis session, the stem cell collection yield was 5.33 x 10⁶ CD34+ cells/kg. There were no observed plerixafor toxicities. The patient underwent successful autologous stem cell transplantation. Times to neutrophil and platelet engraftment were 12 and 15 days, respectively. At 100-day follow-up, the patient's myeloma was in remission and he met all criteria for durable engraftment.
Renal impairment is a common comorbidity in patients with multiple myeloma. Plerixafor is a chemokine receptor 4 antagonist approved for use to mobilize stem cells for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma. To date, there is limited information on safe and effective dosing and administration of plerixafor in patients who are dialysis-dependent. This report describes the use of plerixafor in a patient with multiple myeloma and dialysis-dependent renal failure.
Based on our experience, we are instituting a policy to administer plerixafor at Food and Drug Administration-approved renal adjustment doses in patients on hemodialysis, with dialysis sessions scheduled prior to plerixafor administration and repeated as necessary after apheresis and prior to subsequent plerixafor doses. If clinically feasible, dialysis should be held during the days required to collect stem cells.
报告一例多发性骨髓瘤伴透析依赖肾衰竭患者使用培利昔单抗的情况。
一名 38 岁男性，患有多发性骨髓瘤和透析依赖肾衰竭，正在接受干细胞移植评估。使用 6 剂 10μg/kg/天的粒细胞集落刺激因子（G-CSF）进行干细胞动员，最大预处理前 CD34+计数仅为 5.6 个/μL，结果不理想。该患者在 G-CSF 治疗 4 天后，给予透析后皮下注射培利昔单抗 160μg/kg。单次给予培利昔单抗后，患者预处理前 CD34+计数为 125.6 个/μL。进行 1 次单采后，干细胞采集量为 5.33×106 CD34+细胞/kg。未观察到培利昔单抗的毒性。患者成功进行了自体干细胞移植。中性粒细胞和血小板植入的时间分别为 12 天和 15 天。在 100 天随访时，患者的骨髓瘤处于缓解状态，且满足持久植入的所有标准。
肾功能损害是多发性骨髓瘤患者常见的合并症。培利昔单抗是一种趋化因子受体 4 拮抗剂，已批准用于动员非霍奇金淋巴瘤和多发性骨髓瘤患者的干细胞进行采集和随后的自体移植。迄今为止，关于在依赖透析的患者中安全有效使用培利昔单抗的数据有限。本报告描述了在一名多发性骨髓瘤伴透析依赖肾衰竭患者中使用培利昔单抗的情况。
根据我们的经验，我们正在制定一项政策，即在接受血液透析的患者中按照美国食品药品监督管理局批准的肾脏调整剂量使用培利昔单抗，在培利昔单抗给药前安排透析，在单采后和随后的培利昔单抗剂量前重复进行，如有必要。如果临床可行，应在采集干细胞所需的天数内停止透析。
