Chow Eric, Rao Kamakshi V, Wood William A, Covington Deborah, Armistead Paul M, Coghill James, Serody Jonathan S, Gabriel Don A, Jamieson Katarzyna J, Park Yara A, Raval Jay S, Shea Thomas C
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Biol Blood Marrow Transplant. 2014 Jul;20(7):1064-8. doi: 10.1016/j.bbmt.2014.03.023. Epub 2014 Apr 3.
Autologous stem cell transplantation remains a mainstay of therapy for diseases such as multiple myeloma and relapsed lymphoma. The use of plerixafor has been shown to augment the ability to collect adequate stem cells, but the optimal use of this agent when used with chemotherapy is not yet clear. We utilized an algorithm-based approach with the addition of plerixafor to 54 patients undergoing chemomobilization with reduced-dose etoposide who had a less than optimal preapheresis CD34(+) cell count. We used a CD34(+) precount of 20 cells/μL as a threshold to initiate stem cell apheresis. Ninety-four percent of patients were successfully collected and proceeded to transplantation. Fourteen of 51 (28%) patients who successfully collected required plerixafor to augment stem cell yield. Of the patients who successfully collected, 94% (89% of the entire population) were able to collect in 2 or fewer days. Compared with previous data from our institution, the rate of patients collecting > 4 × 10(6) CD34(+) cells/kg in a single collection was increased from 39% to 69%. The safety profile of this approach was acceptable. The use of this algorithm-based method to determine when and whether to add plerixafor to chemomobilization was shown to be a successful and cost-effective approach to stem cell collection.
自体干细胞移植仍然是治疗多发性骨髓瘤和复发性淋巴瘤等疾病的主要方法。已证明使用普乐沙福可增强采集足够干细胞的能力，但与化疗联合使用时该药物的最佳用法尚不清楚。我们采用基于算法的方法，对54例接受低剂量依托泊苷进行化疗动员且单采前CD34(+)细胞计数不理想的患者加用普乐沙福。我们将CD34(+)细胞计数20个/μL作为启动干细胞单采的阈值。94%的患者成功采集并进行了移植。成功采集的51例患者中有14例(28%)需要普乐沙福来提高干细胞产量。在成功采集的患者中，94%(占全部患者的89%)能够在2天或更短时间内完成采集。与我们机构之前的数据相比，单次采集时采集到>4×10(6)个CD34(+)细胞/kg的患者比例从39%提高到了69%。该方法的安全性可接受。使用这种基于算法的方法来确定何时以及是否在化疗动员中添加普乐沙福，被证明是一种成功且具有成本效益的干细胞采集方法。
