Duong Hien K, Bolwell Brian J, Rybicki Lisa, Koo Anna, Hsi Eric D, Figueroa Priscilla, Dean Robert, Pohlman Brad, Kalaycio Matt, Andresen Steven, Sobecks Ronald, Copelan Edward
Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Clin Apher. 2011;26(3):111-5. doi: 10.1002/jca.20278. Epub 2011 Jan 6.
Early and reliable prediction of the likelihood of achieving adequate stem cell collection for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) would improve collection efficiency, prevent unnecessary aphereses, and permit appropriate treatment alterations. No previous study has reported a threshold CD34+ cell collection quantity on Day 1 or 2 of leukapheresis that could predict successful stem cell collection. We performed a retrospective analysis of all MM patients undergoing first attempt of stem cell collection at our institution from 2001 through 2008. Recursive partitioning analysis was used to identify Day 1 or Day 1+2 CD34+ collection quantity that predicted failure to reach target ≥ 2 × 10(6) CD34+ cells/kg within five days of collection. Totally, 172 patients were included in the analysis. Patients underwent mobilization with G-CSF or G-CSF+ chemotherapy. 23 of 172 patients (13.4%) failed to collect sufficient (≥ 2 × 10(6) CD34+ cells/kg) CD34+ cells after five days of apheresis: 22 of 29 who collected ≤ 0.70 × 10(6) CD34+ cells/kg and 1 of 143 who collected > 0.70 × 10(6) CD34+ cells/kg (75.9% vs. 0.7%, P < 0.001) on Day 1. Collection failure occurred in 23 of 30 patients who collected ≤ 1.54 × 10(6) CD34+ cells/kg and 0 of 142 who collected >1.54 × 10(6) CD34+ cells/kg (76.7% vs. 0%, P < 0.001) on Days 1 + 2. Day 1 CD34+ cell collection quantity identifies patients unlikely to achieve adequate collection for ASCT. Patients who collect ≤ 0.70 × 10(6) CD34+ cells/kg on day 1 could be considered for treatment modifications to improve CD34+ collection, such as early administration of plerixafor or large volume apheresis.
早期且可靠地预测多发性骨髓瘤（MM）患者自体干细胞移植（ASCT）时获得足够干细胞采集量的可能性，将提高采集效率，避免不必要的单采，并允许进行适当的治疗调整。此前尚无研究报道过白细胞单采第1天或第2天的CD34+细胞采集量阈值可预测干细胞采集成功。我们对2001年至2008年在本机构首次尝试进行干细胞采集的所有MM患者进行了回顾性分析。采用递归划分分析来确定预测采集后五天内未能达到目标≥2×10⁶ CD34+细胞/kg的第1天或第1 + 2天的CD34+采集量。分析共纳入172例患者。患者采用粒细胞集落刺激因子（G-CSF）或G-CSF + 化疗进行动员。172例患者中有23例（13.4%）在单采五天后未能采集到足够（≥2×10⁶ CD34+细胞/kg）的CD34+细胞：第1天采集量≤0.70×10⁶ CD34+细胞/kg的29例患者中有22例，采集量>0.70×10⁶ CD34+细胞/kg的143例患者中有1例（75.9%对0.7%，P < 0.001）。第1 + 2天采集量≤1.54×10⁶ CD34+细胞/kg的30例患者中有23例采集失败，采集量>1.54×10⁶ CD34+细胞/kg的142例患者中无采集失败（76.7%对0%，P < 0.001）。第1天的CD34+细胞采集量可识别出不太可能为ASCT获得足够采集量的患者。第1天采集量≤0.70×10⁶ CD34+细胞/kg的患者可考虑进行治疗调整以提高CD34+采集量，如早期给予普乐沙福或大容量单采。
