Yuan Shan, Palmer Joycelynne M, Tsai Ni-Chun, Dagis Andrew, Nademanee Auayporn, Wang Shirong
Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, CA, USA.
Division of Biostatistics, Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA.
Hematol Oncol. 2017 Sep;35(3):281-287. doi: 10.1002/hon.2286. Epub 2016 Feb 29.
Plerixafor has been used to improve peripheral blood stem cell (PBSC) mobilization in multiple myeloma, non-Hodgkin lymphoma, and very recently in Hodgkin lymphoma (HL) patients. Because prior studies have suggested that mobilization with plerixafor affects the composition of mobilized cells, there are concerns that this may in turn adversely impact the immune reconstitution and longer term outcomes of transplanted patients. However, data on the engraftment characteristics and long-term post-transplant outcomes in patients transplanted with plerixafor-mobilized PBSCs are lacking. This retrospective study examined the post-transplant outcomes of 105 consecutive adult HL patients, and compared the post-transplant outcomes of 21 patients who received plerixafor in addition to G-CSF ± chemotherapy because of poor mobilization with those of 84 patients who mobilized well without plerixafor. Despite collecting significantly lower CD34+ cell doses (median of 3.41 vs. 6.05 × 10 /kg, p < 0.0001) than control patients and requiring more collection days, plerixafor-mobilized patients showed comparable early engraftment characteristics, except for slightly delayed neutrophil engraftment (median: 11 vs.10 days, p = 0.002) and lower median neutrophil counts (2.1 vs. 2.6 × 10 /L, p = 0.04) at one month after transplant. No significant differences were observed in longer term post-transplant outcomes, including cell counts at 3, 6, and 12 months, RBC and platelet transfusion support during the first 120 days, relapse incidence, overall and progression-free survival rates up to two years post transplant. The use of plerixafor not only enabled poorly mobilizing HL patients to collect enough PBSCs to proceed to ASCT, but also to have similar post-transplant outcomes compared to patients who mobilized well with conventional regimens. Copyright © 2016 John Wiley & Sons, Ltd.
普乐沙福已被用于改善多发性骨髓瘤、非霍奇金淋巴瘤患者的外周血干细胞（PBSC）动员，最近也用于霍奇金淋巴瘤（HL）患者。由于先前的研究表明，使用普乐沙福进行动员会影响动员细胞的组成，因此有人担心这可能反过来对移植患者的免疫重建和长期预后产生不利影响。然而，关于接受普乐沙福动员的PBSC移植患者的植入特征和移植后长期预后的数据尚缺乏。这项回顾性研究检查了105例连续成年HL患者的移植后预后，并比较了21例因动员不佳除接受G-CSF±化疗外还接受普乐沙福的患者与84例未使用普乐沙福但动员良好的患者的移植后预后。尽管与对照患者相比，普乐沙福动员的患者收集的CD34 +细胞剂量明显更低（中位数为3.41对6.05×10⁶/kg，p <0.0001）且需要更多的采集天数，但除了中性粒细胞植入稍有延迟（中位数：11对10天，p = 0.002）以及移植后1个月时中性粒细胞计数中位数较低（2.1对2.6×10⁹/L，p = 0.04）外，普乐沙福动员的患者显示出相当的早期植入特征。在移植后长期预后方面未观察到显著差异，包括移植后3、6和12个月时的细胞计数、前120天内的红细胞和血小板输血支持、复发率、移植后两年内的总生存率和无进展生存率。使用普乐沙福不仅使动员不佳的HL患者能够收集足够的PBSC以进行自体干细胞移植（ASCT），而且与使用传统方案动员良好的患者相比，移植后预后相似。版权所有©2016约翰威立父子有限公司。
