Dhakal Binod, Veltri Lauren Westfall, Fenske Timothy S, Eastwood Daniel, Craig Michael D, Cumpston Aaron, Shillingburg Alexandra, Esselman Jean, Watkins Kathy, Pasquini Marcelo C, D'Souza Anita, Hari Parameswaran, Kanate Abraham Sebastian, Hamadani Mehdi
Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
Biol Blood Marrow Transplant. 2016 Oct;22(10):1773-1780. doi: 10.1016/j.bbmt.2016.06.016. Epub 2016 Jun 21.
Studies comparing the efficacy and safety of chemo-mobilization with ifosfamide, carboplatin, and etoposide (ICE) ± rituximab with plerixafor-based approaches in lymphoma patients have not been performed. We analyzed hematopoietic progenitor cell mobilization outcomes in lymphoma patients undergoing chemo-mobilization with ICE (n = 35) compared with either routine plerixafor (n = 30) or "just in time" (JIT) plerixafor-based mobilization (n = 33). Chemo-mobilization provided a significantly higher total CD34(+) cell yield (median collection, 5.35 × 10(6) cells/kg for ICE versus 3.15 × 10(6) cells/kg for routine plerixafor and 3.6 × 10(6) cells/kg for JIT plerixafor, P < .001). The median day 1 yield of CD34(+) cells was not significantly different (median, 2.2 × 10(6) cells/kg in ICE versus 1.9 × 10(6) cells/kg in upfront plerixafor versus 1.7 × 10(6) cells/kg in JIT plerixafor, P = .20). There was no significant difference in the 3 groups in terms of total number of apheresis sessions performed (median, 2 in each group; P = .78). There were no mobilization failures (inability to collect at least 2 × 10(6) cells/kg) in the chemo-mobilization group, whereas 5 patients (16.7%) in the routine plerixafor and 3 patients (9.1%) in JIT group had mobilization failure (P = .04). Mean time to neutrophil engraftment was faster in the chemo-mobilization group, 10.3 days (±1.2) compared with 12.1 days (±3.6) in the routine plerixafor group and 11.6 days (±3.0) in the JIT group (P < .001) and mean time to platelet engraftment was 13.7 days (±.7) in ICE versus 20.3 days (±1.6) in routine plerixafor versus 17.1 days (± .9) in JIT group (P < .001). Red blood cell transfusions were significantly higher in the chemo-mobilization group (34.3% versus 0 versus 3.2% versus 1, P < .001) and so were the platelet transfusions (22.9% versus 0 versus 0, P < .001). Excluding the cost of chemotherapy administration, chemo-mobilization was associated with significantly less mobilization cost (average cost $17,601.76 in ICE versus $28,963.05 in routine and $25,679.81 in JIT, P < .001). Our data suggests that chemo-mobilization with ICE provides a higher total CD34(+) cell yield, lower rates of mobilization failure, faster engraftment, and lower cost compared to plerixafor-based approaches with comparable toxicity profile between the groups, except for higher transfusion requirements with chemo-mobilization.
尚未开展研究比较在淋巴瘤患者中使用异环磷酰胺、卡铂和依托泊苷（ICE）±利妥昔单抗进行化疗动员与基于普乐沙福的方法的疗效和安全性。我们分析了接受ICE化疗动员的淋巴瘤患者（n = 35）与常规普乐沙福（n = 30）或“及时”（JIT）基于普乐沙福的动员（n = 33）相比的造血祖细胞动员结果。化疗动员提供了显著更高的总CD34(+)细胞产量（中位采集量，ICE组为5.35×10⁶细胞/kg，常规普乐沙福组为3.15×10⁶细胞/kg，JIT普乐沙福组为3.6×10⁶细胞/kg，P <.001）。第1天CD34(+)细胞的中位产量无显著差异（中位值，ICE组为2.2×10⁶细胞/kg， upfront普乐沙福组为1.9×10⁶细胞/kg，JIT普乐沙福组为1.7×10⁶细胞/kg，P = 0.20）。三组进行的单采次数总数无显著差异（中位值，每组均为2次；P = 0.78）。化疗动员组没有动员失败（无法采集到至少2×10⁶细胞/kg）的情况，而常规普乐沙福组有5例患者（16.7%）、JIT组有3例患者（9.1%）出现动员失败（P = 0.04）。化疗动员组中性粒细胞植入的平均时间更快，为10.3天（±1.2），而常规普乐沙福组为12.1天（±3.6），JIT组为11.6天（±3.0）（P <.001），ICE组血小板植入的平均时间为13.7天（±0.7），常规普乐沙福组为20.3天（±1.6），JIT组为17.1天（±0.9）（P <.001）。化疗动员组的红细胞输血率显著更高（34.3% 对0对3.2%对1，P <.001），血小板输血率也是如此（22.9%对0对0，P <.001）。排除化疗给药成本后，化疗动员的动员成本显著更低（ICE组平均成本为17,601.76美元，常规组为28,963.05美元，JIT组为25,679.81美元，P <.001）。我们的数据表明，与基于普乐沙福的方法相比，使用ICE进行化疗动员可提供更高的总CD34(+)细胞产量、更低的动员失败率、更快的植入速度以及更低的成本，两组之间毒性特征相当，只是化疗动员的输血需求更高。
