Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Leukemia. 2014 Apr;28(4):888-93. doi: 10.1038/leu.2013.214. Epub 2013 Jul 15.
Collection of hematopoietic progenitor cells (HPC) after previous autologous hematopoietic progenitor cell transplant (aHCT) was studied in 221 patients with multiple myeloma (MM). With a total of 333 collections, the median number of CD34+ cells collected was 4.7 × 10(6) CD34+ cells/kg, and 74% of the patients collected ≥ 2.5 × 10(6) CD34+ cells/kg. Among 26 variables examined, the strongest predictor for poor collection was a platelet count <100 × 10(6)/l before mobilization (P<0.001). A subsequent aHCT was performed in 154 of the 221 patients. Sole use of HPC procured after aHCT in 86 patients was associated with delayed platelet recovery (P<0.001) and linked to development of myelodysplastic syndrome (MDS)-associated cytogenetic abnormalities (MDS-CA; P=0.027, odds ratio (OR) 10.34) and a tendency towards clinical MDS/acute myeloid leukemia (AML; P=0.091, OR 3.57). However, treatment-related mortality (P=0.766) and time to absolute neutrophil count recovery ≥0.5 × 10(9)/l (P=0.879) were similar to when a pre-aHCT graft was used. Indeed, adding HPC collected before any aHCT neutralized the risk of MDS-CA or MDS/AML. Therefore, we advise generous initial HPC collection to broaden the salvage armamentarium for patients with MM.
在 221 例多发性骨髓瘤（MM）患者中研究了先前自体造血祖细胞移植（aHCT）后的造血祖细胞（HPC）采集情况。共采集了 333 次，中位数采集的 CD34+细胞数为 4.7×10（6）个 CD34+细胞/kg，74%的患者采集了≥2.5×10（6）个 CD34+细胞/kg。在检查的 26 个变量中，动员前血小板计数<100×10（6）/l 是采集效果差的最强预测因素（P<0.001）。在 221 例患者中，有 154 例随后进行了 aHCT。在 86 例患者中，仅使用 aHCT 后采集的 HPC 与血小板恢复延迟相关（P<0.001），并与骨髓增生异常综合征（MDS）相关细胞遗传学异常（MDS-CA；P=0.027，优势比（OR）10.34）和临床 MDS/急性髓系白血病（AML；P=0.091，OR 3.57）的发展相关。然而，治疗相关死亡率（P=0.766）和中性粒细胞绝对计数恢复至≥0.5×10（9）/l 的时间（P=0.879）与使用 pre-aHCT 移植物时相似。实际上，添加在任何 aHCT 之前采集的 HPC 可消除 MDS-CA 或 MDS/AML 的风险。因此，我们建议初始 HPC 采集要慷慨，以扩大 MM 患者的挽救治疗手段。
