Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Department of Hematology, Department of Pharmacy, City of Hope National Medical Center, Duarte, California.
Transfusion. 2013 Dec;53(12):3244-50. doi: 10.1111/trf.12198. Epub 2013 Apr 22.
Plerixafor is a recently introduced agent used to improve peripheral blood stem cell (PBSC) mobilization in patients with hematologic malignancies. However, some patients still cannot mobilize adequately even with plerixafor.
We retrospectively reviewed the PBSC collections of 18 consecutive lymphoma and multiple myeloma patients, who had previously mobilized poorly despite the use of plerixafor and received plerixafor again during remobilization.
During the first mobilization attempt, all 18 recombinant granulocyte-colony-stimulating factor (G-CSF; two) or G-CSF plus chemotherapy-mobilized patients (16) had poor response to plerixafor, with peripheral blood (PB) CD34+ counts ranging from 0 to 7.48 × 10(6)/L after the first dose. They collected only 0.15 × 10(6) to 1.63 × 10(6) (median, 0.40 × 10(6)) CD34+ cells/kg after one to four collections. The median average daily yield was 0.24 × 10(6) CD34+ cells/kg. Remobilization began 1 to 4 weeks later with G-CSF, plerixafor, and with (three) or without (15) cyclophosphamide. The PB CD34+ cell counts after the first dose of plerixafor were 3.04 × 10(6) to 127.54 × 10(6)/L (median, 14.58 × 10(6)/L). After one to four doses of plerixafor, each patient collected an additional 0.39 × 10(6) to 14.02 × 10(6) (median, 1.89 × 10(6)) CD34+ cells/kg, and the median daily average was 0.78 × 10(6) CD34+ cells/kg. Cumulatively, after two rounds of collections, 15 collected more than 2.0 × 10(6) CD34+ cells/kg. Thirteen have proceeded to autologous stem cell transplantation (ASCT) and successfully engrafted.
In patients who had responded poorly to the use of plerixafor as a mobilization salvage agent, response to remobilization with plerixafor for the second time was variable, but most (83.3%) patients were able to collect enough PBSCs to proceed to ASCT.
plerixafor 是一种最近引入的药物，用于改善血液系统恶性肿瘤患者的外周血造血干细胞（PBSC）动员。然而，有些患者即使使用 plerixafor 也不能充分动员。
我们回顾性分析了 18 例连续淋巴瘤和多发性骨髓瘤患者的 PBSC 采集情况，这些患者之前曾使用 plerixafor 进行动员，但效果不佳，在重新动员时再次使用 plerixafor。
在第一次动员尝试中，所有 18 例重组粒细胞集落刺激因子（G-CSF；2 例）或 G-CSF 联合化疗动员的患者（16 例）对 plerixafor 的反应较差，首次剂量后外周血（PB）CD34+计数为 0 至 7.48×106/L。他们在 1 至 4 次采集后仅采集到 0.15×106 至 1.63×106（中位数，0.40×106）CD34+细胞/kg。中位平均日产量为 0.24×106 CD34+细胞/kg。动员在 1 至 4 周后开始，使用 G-CSF、plerixafor 以及（3 例）或不使用（15 例）环磷酰胺。首次给予 plerixafor 后 PB CD34+细胞计数为 3.04×106 至 127.54×106/L（中位数，14.58×106/L）。给予 1 至 4 剂 plerixafor 后，每位患者额外采集 0.39×106 至 14.02×106（中位数，1.89×106）CD34+细胞/kg，中位每日平均采集量为 0.78×106 CD34+细胞/kg。两次采集后，15 例患者累计采集 CD34+细胞超过 2.0×106/kg。13 例患者已进行自体干细胞移植（ASCT）并成功植入。
在对 plerixafor 作为动员补救剂反应不佳的患者中，第二次使用 plerixafor 进行再动员的反应各不相同，但大多数（83.3%）患者能够采集足够的 PBSC 进行 ASCT。
