Mohty M, Hübel K, Kröger N, Aljurf M, Apperley J, Basak G W, Bazarbachi A, Douglas K, Gabriel I, Garderet L, Geraldes C, Jaksic O, Kattan M W, Koristek Z, Lanza F, Lemoli R M, Mendeleeva L, Mikala G, Mikhailova N, Nagler A, Schouten H C, Selleslag D, Suciu S, Sureda A, Worel N, Wuchter P, Chabannon C, Duarte R F
Department of Haematology, Saint Antoine Hospital, Paris, France.
University Hospital Cologne, Cologne, Germany.
Bone Marrow Transplant. 2014 Jul;49(7):865-72. doi: 10.1038/bmt.2014.39. Epub 2014 Mar 31.
Autologous haematopoietic SCT with PBSCs is regularly used to restore BM function in patients with multiple myeloma or lymphoma after myeloablative chemotherapy. Twenty-eight experts from the European Group for Blood and Marrow Transplantation developed a position statement on the best approaches to mobilising PBSCs and on possibilities of optimising graft yields in patients who mobilise poorly. Choosing the appropriate mobilisation regimen, based on patients' disease stage and condition, and optimising the apheresis protocol can improve mobilisation outcomes. Several factors may influence mobilisation outcomes, including older age, a more advanced disease stage, the type of prior chemotherapy (e.g., fludarabine or melphalan), prior irradiation or a higher number of prior treatment lines. The most robust predictive factor for poor PBSC collection is the CD34(+) cell count in PB before apheresis. Determination of the CD34(+) cell count in PB before apheresis helps to identify patients at risk of poor PBSC collection and allows pre-emptive intervention to rescue mobilisation in these patients. Such a proactive approach might help to overcome deficiencies in stem cell mobilisation and offers a rationale for the use of novel mobilisation agents.
自体造血干细胞移植联合外周血干细胞常用于在清髓性化疗后恢复多发性骨髓瘤或淋巴瘤患者的骨髓功能。欧洲血液与骨髓移植组的28位专家就动员外周血干细胞的最佳方法以及优化动员效果不佳患者的移植物产量的可能性制定了一份立场声明。根据患者的疾病分期和状况选择合适的动员方案,并优化单采程序,可以改善动员效果。几个因素可能会影响动员效果,包括年龄较大、疾病分期较晚、既往化疗类型(如氟达拉滨或美法仑)、既往放疗或既往治疗线数较多。外周血干细胞采集不佳最有力的预测因素是单采前外周血中的CD34(+)细胞计数。单采前测定外周血中的CD34(+)细胞计数有助于识别外周血干细胞采集不佳风险的患者,并允许对这些患者进行抢先干预以挽救动员效果。这种积极主动的方法可能有助于克服干细胞动员方面的不足,并为使用新型动员剂提供了理论依据。