Antar A, Otrock Z K, Kharfan-Dabaja M A, Ghaddara H A, Kreidieh N, Mahfouz R, Bazarbachi A
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Pathology and Immunology, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA.
Bone Marrow Transplant. 2015 Jun;50(6):813-7. doi: 10.1038/bmt.2015.23. Epub 2015 Mar 9.
The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. We retrospectively compared our experience in hematopoietic cell mobilization in 83 MM patients using fractionated high-dose CY and G-CSF with G-CSF plus preemptive plerixafor. All patients in the CY group (n=56) received fractionated high-dose CY (5 g/m(2) divided into five doses of 1 g/m(2) every 3 h) with G-CSF. All patients in the plerixafor group (n=27) received G-CSF and plerixafor preemptively based on an established algorithm. Compared with plerixafor, CY use was associated with higher total CD34+ cell yield (7.5 × 10(6) vs 15.5 × 10(6) cells/kg, P=0.005). All patients in both groups yielded ⩾4 × 10(6) CD34+ cells/kg. Conversely, CY use was associated with high frequency of febrile neutropenia, blood and platelet transfusions need and hospitalizations. The average total cost of mobilization in Lebanon was slightly higher in the plerixafor group ($7886 vs $7536; P=0.16). Our data indicate robust stem cell mobilization in MM patients with either fractionated high-dose CY and G-CSF or G-CSF alone with preemptive plerixafor. The chemo-mobilization approach was associated with twofold stem cell yield, slightly lower cost but significantly increased toxicity.
多发性骨髓瘤（MM）患者的最佳干细胞动员方案仍未明确。我们回顾性比较了83例MM患者采用分次大剂量环磷酰胺（CY）联合粒细胞集落刺激因子（G-CSF）与G-CSF加抢先使用普乐沙福进行造血细胞动员的经验。CY组的所有患者（n = 56）接受分次大剂量CY（5 g/m²，分为5剂，每3小时1 g/m²）联合G-CSF。普乐沙福组的所有患者（n = 27）根据既定算法抢先接受G-CSF和普乐沙福。与普乐沙福相比，使用CY与更高的总CD34⁺细胞产量相关（7.5×10⁶对15.5×10⁶细胞/kg，P = 0.005）。两组所有患者的CD34⁺细胞产量均≥4×10⁶细胞/kg。相反，使用CY与发热性中性粒细胞减少、血液和血小板输注需求及住院的高频率相关。黎巴嫩动员的平均总成本在普乐沙福组略高（7886美元对7536美元；P = 0.16）。我们的数据表明，采用分次大剂量CY联合G-CSF或单独使用G-CSF加抢先使用普乐沙福均可使MM患者实现强劲的干细胞动员。化疗动员方法与干细胞产量增加两倍、成本略低但毒性显著增加相关。
