Poenisch Wolfram, Plötze Madlen, Holzvogt Bruno, Andrea Marc, Schliwa Thomas, Zehrfeld Thomas, Hammerschmidt Doreen, Schwarz Maik, Edelmann Thomas, Becker Cornelia, Hoffmann Franz Albert, Schwarzer Andreas, Kreibich Ute, Gutsche Kerstin, Reifenrath Kolja, Schwarzbach Heidrun, Heyn Simone, Franke Georg-Nikolaus, Jentzsch Madlen, Leiblein Sabine, Schwind Sebastian, Lange Thoralf, Vucinic Vladan, AlAli Haifa-Katrin, Niederwieser Dietger
Department of Hematology, University of Leipzig, Johannisallee 32a, 04103, Leipzig, Germany.
Hospital Torgau, Christianistr. 1, 04860, Torgau, Germany.
J Cancer Res Clin Oncol. 2015 Nov;141(11):2013-22. doi: 10.1007/s00432-015-1984-4. Epub 2015 May 15.
Reliable information on stem cell toxicity and mobilization of stem cells for autologous stem cell transplantation (SCT) after induction treatment with a combination of bendamustine, prednisone and bortezomib (BPV) is missing.
A retrospective analysis of peripheral blood stem cell mobilization and autologous SCT was performed in 35 patients with MM who had received at least one cycle of a BPV-induction therapy consisting of bendamustine 60 mg/m(2) on days 1 and 2, bortezomib 1.3 mg/m(2) on days 1, 4, 8 and 11 and prednisone 100 mg on days 1, 2, 4, 8 and 11 between October 2008 and May 2014. The mobilization regimen consisted of cyclophosphamide 4 g/m(2) and G-CSF (2 × 5 μg/kg). Apheresis was started as soon as peripheral CD34(+) counts exceeded 20 × 10(6)/L with a harvest target of 8 × 10(6) CD34(+)/kg. The minimal accepted target was 2 × 10(6) CD34(+)/kg. The transplantation conditioning therapy consisted of melphalan 200 mg/m(2).
A median number of two (range 1-5) BPV cycles were given. The majority of patients (n = 31, 89 %) responded with two sCR, five nCR, 11 VGPR and 13 PR after BPV induction. Three patients had MR, and one SD. Stem cell mobilization and harvest were successful in all patients. In 19 of 35 patients (54 %), a single apheresis was sufficient to reach the target. The median number of aphereses was one (range 1-4), and the median CD34(+) cell-count/kg was 13.5 (range 3.2-33.1) × 106. All patients received an autologous SCT. Engraftment was successful in 34 of 35 patients. The median time to a leukocyte count >l × 10(9)/L was 11 days, and the time to untransfused platelet count of >50 × 10(9)/L was 13 days. Thirty-four patients (97 %) responded after the autologous SCT with 11 sCR, two CR, seven nCR, seven VGPR and seven PR. The progression-free survival at 18 months was 87 %, and overall survival was 92 %.
Stem cell mobilization and autologous SCT are feasible in MM patients who have received BPV-induction therapy .
关于苯达莫司汀、泼尼松和硼替佐米（BPV）联合诱导治疗后自体干细胞移植（SCT）中干细胞毒性及干细胞动员的可靠信息尚缺。
对35例接受过至少1周期BPV诱导治疗的多发性骨髓瘤（MM）患者进行外周血干细胞动员及自体SCT的回顾性分析。BPV诱导治疗方案为：第1天和第2天给予苯达莫司汀60mg/m²，第1、4、8和11天给予硼替佐米1.3mg/m²，第1、2、4、8和11天给予泼尼松100mg。动员方案为环磷酰胺4g/m²和粒细胞集落刺激因子（G-CSF）（2×5μg/kg）。一旦外周血CD34⁺细胞计数超过20×10⁶/L即开始单采，采集目标为8×10⁶CD34⁺/kg。最低可接受目标为2×10⁶CD34⁺/kg。移植预处理方案为美法仑200mg/m²。
BPV周期数中位数为2（范围1 - 5）。多数患者（n = 31，89%）在BPV诱导后获得2例严格完全缓解（sCR）、5例完全缓解（nCR）、11例非常好的部分缓解（VGPR）和13例部分缓解（PR）。3例患者为微小缓解（MR），1例为疾病稳定（SD）。所有患者干细胞动员及采集均成功。35例患者中有19例（54%）单次单采即达到目标。单采次数中位数为1（范围1 - 4），CD34⁺细胞计数/kg中位数为13.5（范围3.2 - 33.1）×10⁶。所有患者均接受自体SCT。35例患者中有34例移植成功。白细胞计数>1×10⁹/L的中位时间为11天，血小板计数>50×10⁹/L且无需输血的时间为13天。34例患者（97%）在自体SCT后获得缓解，包括11例sCR、2例CR、7例nCR、7例VGPR和7例PR。18个月时无进展生存率为87%，总生存率为92%。
接受BPV诱导治疗的MM患者进行干细胞动员及自体SCT是可行的。
