Chaudhary Lubna, Awan Farrukh, Cumpston Aaron, Leadmon Sonia, Watkins Kathy, Tse William, Craig Michael, Hamadani Mehdi
Section of Hematology and Oncology, West Virginia University, Morgantown, West Virginia.
J Clin Apher. 2013 Oct;28(5):359-67. doi: 10.1002/jca.21280. Epub 2013 Jun 14.
Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low-dose cyclophosphamide (LD-CY) and granulocyte-colony stimulating factor (G-CSF) against plerixafor and G-CSF, in multiple myeloma (MM) patients treated in the novel therapy-era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1-year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD-CY (1.5 gm/m(2)) and G-CSF (n = 74) were compared against patients receiving plerixafor and G-CSF (n = 33). Compared to plerixafor, LD-CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 10(6)/kg vs. 2.4 × 10(6)/kg, P = 0.001). Six patients (8.1%) in the LD-CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 10(6)/kg vs. 7 × 10(6)/kg; P-value = 0.001). Mobilization with LD-CY was associated with increased (albeit statistically non-significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD-CY group ($28,980 vs. $19,626.5 P-value < 0.0001). In conclusion, in MM plerixafor-based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD-CY mobilization. Our data caution against the use of LD-CY in MM patients for mobilization, especially after induction with lenalidomide-containing regimens.
在新疗法时代接受治疗的多发性骨髓瘤（MM）患者中，尚无关于低剂量环磷酰胺（LD-CY）联合粒细胞集落刺激因子（G-CSF）与普乐沙福联合G-CSF进行外周血干细胞和祖细胞动员的疗效及成本比较的研究。在此，我们报告了107例在开始使用新型药物进行诱导化疗后1年内接受移植的患者的动员结果。将接受LD-CY（1.5 gm/m(2)）联合G-CSF动员的患者（n = 74）与接受普乐沙福联合G-CSF动员的患者（n = 33）进行比较。与普乐沙福相比，LD-CY与外周血CD34+细胞计数的中位数峰值显著降低相关（68/µL对36/µL，P = 0.048），且采集第1天的CD34+细胞产量较低（6.9×10(6)/kg对2.4×10(6)/kg，P = 0.001）。LD-CY组有6例患者（8.1%）动员失败，而普乐沙福组无患者失败。普乐沙福组的总CD34+细胞产量显著更高（中位数11.6×10(6)/kg对7×10(6)/kg；P值 = 0.001）。LD-CY动员与发热性中性粒细胞减少发作增加（尽管无统计学意义）相关（5.4%对0%；P = 0.24），静脉使用抗生素的比例更高（6.7%对3%；P = 0.45），以及住院需求增加（9.4%对3%；P = 0.24）。普乐沙福组的平均总动员成本显著高于LD-CY组（28,980美元对19,626.5美元，P值 < 0.0001）。总之，在MM患者中，基于普乐沙福的动员具有更高的疗效，但与LD-CY动员相比，动员成本显著更高。我们的数据提醒不要在MM患者中使用LD-CY进行动员，尤其是在接受含来那度胺方案诱导治疗后。
