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化疗动员对接受自体造血细胞移植治疗的多发性骨髓瘤疾病控制的贡献。

Contribution of chemotherapy mobilization to disease control in multiple myeloma treated with autologous hematopoietic cell transplantation.

作者信息

Uy G L, Costa L J, Hari P N, Zhang M-J, Huang J-X, Anderson K C, Bredeson C N, Callander N S, Cornell R F, Perez M A D, Dispenzieri A, Freytes C O, Gale R P, Garfall A, Gertz M A, Gibson J, Hamadani M, Lazarus H M, Kalaycio M E, Kamble R T, Kharfan-Dabaja M A, Krishnan A Y, Kumar S K, Kyle R A, Landau H J, Lee C H, Maiolino A, Marks D I, Mark T M, Munker R, Nishihori T, Olsson R F, Ramanathan M, Rodriguez T E, Saad A A, Savani B N, Schiller G J, Schouten H C, Schriber J R, Scott E, Seo S, Sharma M, Ganguly S, Stadtmauer E A, Tay J, To L B, Vesole D H, Vogl D T, Wagner J L, Wirk B, Wood W A, D'Souza A

机构信息

Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.

Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

Bone Marrow Transplant. 2015 Dec;50(12):1513-8. doi: 10.1038/bmt.2015.190. Epub 2015 Aug 24.

Abstract

In patients with multiple myeloma (MM) undergoing autologous hematopoietic cell transplantation (auto-HCT), peripheral blood progenitor cells may be collected following mobilization with growth factor alone (GF) or cytotoxic chemotherapy plus GF (CC+GF). It is uncertain whether the method of mobilization affects post-transplant outcomes. We compared these mobilization strategies in a retrospective analysis of 968 patients with MM from the Center for International Blood and Marrow Transplant Research database who received an auto-HCT in the US and Canada between 2007 and 2012. The kinetics of neutrophil engraftment (⩾0.5 × 10(9)/L) was similar between groups (13 vs 13 days, P=0.69) while platelet engraftment (⩾20 × 10(9)/L) was slightly faster with CC+GF (19 vs 18 days, P=0.006). Adjusted 3-year PFS was 43% (95% confidence interval (CI) 38-48) in GF and 40% (95% CI 35-45) in CC+GF, P=0.33. Adjusted 3-year OS was 82% (95% CI 78-86) vs 80% (95% CI 75-84), P=0.43 and adjusted 5-year OS was 62% (95% CI 54-68) vs 60% (95% CI 52-67), P=0.76, for GF and CC+GF, respectively. We conclude that MM patients undergoing auto-HCT have similar outcomes irrespective of the method of mobilization and found no evidence that the addition of chemotherapy to mobilization contributes to disease control.

摘要

在接受自体造血细胞移植(auto-HCT)的多发性骨髓瘤(MM)患者中,外周血祖细胞可在单独使用生长因子(GF)动员或细胞毒性化疗加生长因子(CC+GF)后采集。动员方法是否会影响移植后的结局尚不确定。我们对国际血液和骨髓移植研究中心数据库中968例2007年至2012年在美国和加拿大接受auto-HCT的MM患者进行了回顾性分析,比较了这些动员策略。两组中性粒细胞植入(⩾0.5×10⁹/L)的动力学相似(13天对13天,P=0.69),而CC+GF组血小板植入(⩾20×10⁹/L)稍快(19天对18天,P=0.006)。GF组调整后的3年无进展生存期(PFS)为43%(95%置信区间(CI)38-48),CC+GF组为40%(9%CI 35-45),P=0.33。GF组和CC+GF组调整后的3年总生存期(OS)分别为82%(95%CI 78-86)和80%(95%CI 75-84),P=0.43;调整后的5年OS分别为62%(95%CI 54-68)和60%(95%CI 52-67),P=0.76。我们得出结论,接受auto-HCT的MM患者无论采用何种动员方法,结局相似,且没有证据表明动员时添加化疗有助于疾病控制。

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