Salvino Marco Aurélio, Ruiz Jefferson
Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
Sanofi, Brazil.
Rev Bras Hematol Hemoter. 2016 Jan-Feb;38(1):28-36. doi: 10.1016/j.bjhh.2015.07.011. Epub 2015 Aug 19.
The use of high-dose chemotherapy with autologous support of hematopoietic progenitor cells is an effective strategy to treat various hematologic neoplasms, such as non-Hodgkin lymphomas and multiple myeloma. Mobilized peripheral blood progenitor cells are the main source of support for autologous transplants, and collection of an adequate number of hematopoietic progenitor cells is a critical step in the autologous transplant procedure. Traditional strategies, based on the use of growth factors with or without chemotherapy, have limitations even when remobilizations are performed. Granulocyte colony-stimulating factor is the most widely used agent for progenitor cell mobilization. The association of plerixafor, a C-X-C Chemokine receptor type 4 (CXCR4) inhibitor, to granulocyte colony stimulating factor generates rapid mobilization of hematopoietic progenitor cells. A literature review was performed of randomized studies comparing different mobilization schemes in the treatment of multiple myeloma and lymphomas to analyze their limitations and effectiveness in hematopoietic progenitor cell mobilization for autologous transplant. This analysis showed that the addition of plerixafor to granulocyte colony stimulating factor is well tolerated and results in a greater proportion of patients with non-Hodgkin lymphomas or multiple myeloma reaching optimal CD34(+) cell collections with a smaller number of apheresis compared the use of granulocyte colony stimulating factor alone.
使用高剂量化疗并辅以自体造血祖细胞支持是治疗各种血液系统肿瘤（如非霍奇金淋巴瘤和多发性骨髓瘤）的有效策略。动员的外周血祖细胞是自体移植支持的主要来源，采集足够数量的造血祖细胞是自体移植过程中的关键步骤。基于使用生长因子（有或无化疗）的传统策略存在局限性，即使进行再动员也是如此。粒细胞集落刺激因子是用于祖细胞动员最广泛使用的药物。趋化因子受体4（CXCR4）抑制剂普乐沙福与粒细胞集落刺激因子联合使用可快速动员造血祖细胞。对比较治疗多发性骨髓瘤和淋巴瘤的不同动员方案的随机研究进行了文献综述，以分析它们在自体移植造血祖细胞动员中的局限性和有效性。该分析表明，与单独使用粒细胞集落刺激因子相比，在粒细胞集落刺激因子中添加普乐沙福耐受性良好，并且导致更大比例的非霍奇金淋巴瘤或多发性骨髓瘤患者通过较少次数的单采达到最佳CD34(+)细胞采集量。
