Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
Bone Marrow Transplant. 2012 Dec;47(12):1526-9. doi: 10.1038/bmt.2012.74. Epub 2012 May 7.
Plerixafor augments PBSC collection, but the optimal approach for incorporating it into mobilization is uncertain. Forty-nine consecutive patients mobilized with G-CSF alone were analyzed, and a day 4 peripheral blood CD34(+) cell count of 0.015/ml was found to predict for a day 5 apheresis yield of 2 × 10(6) CD34(+) progenitors/kg, our institutional minimum necessary for a single autologous transplant. On the basis of this relationship, a clinical guideline was developed which recommended pre-emptive use of plerixafor if the day 4 peripheral blood CD34(+) cell count was between 0.005 and 0.015/ml. A total of 166 consecutive subjects with lymphoma or plasma cell dyscrasias underwent G-CSF mobilization after adoption of this care pathway, and the mobilization failure rate was only 7% in patients managed per guideline. The median PBSC yield was 6.3 × 10(6) CD34(+) progenitors/kg with G-CSF (day 4 peripheral blood CD34(+) cell > 0.015/ml) and 4.9 × 10(6) CD34(+) progenitors/kg with G-CSF+plerixafor (day 4 peripheral blood CD34(+) cell 0.005-0.015/ml). The median number of days of apheresis was 2 in both groups. This clinical guideline is an effective mobilization algorithm that minimizes mobilization failures, reduces poor apheresis yields, does not require risk factor identification and is simple to implement.
培利昔洛韦可增加 PBSC 的采集量，但最佳的应用方法仍不确定。我们分析了 49 例单独使用 G-CSF 进行动员的连续患者，发现第 4 天外周血 CD34+细胞计数为 0.015/ml 可预测第 5 天的单采收获量达到 2×106 CD34+祖细胞/kg，这是我们机构进行单次自体移植的最低要求。基于这一关系，制定了一个临床指南，建议如果第 4 天外周血 CD34+细胞计数在 0.005 至 0.015/ml 之间，应预先使用培利昔洛韦。采用这一护理途径后，共有 166 例淋巴瘤或浆细胞疾病患者接受 G-CSF 动员，按照指南管理的患者动员失败率仅为 7%。在 G-CSF 组（第 4 天外周血 CD34+细胞>0.015/ml）和 G-CSF+培利昔洛韦组（第 4 天外周血 CD34+细胞 0.005-0.015/ml），PBSC 的中位产量分别为 6.3×106 CD34+祖细胞/kg 和 4.9×106 CD34+祖细胞/kg。两组的中位单采天数均为 2 天。该临床指南是一种有效的动员算法，可最大程度地减少动员失败，降低不良单采产量，无需确定危险因素，易于实施。
