Moreb Jan S, Byrne Michael, Shugarman Ilicia, Zou Fei, Xiong Sican, May William S, Norkin Maxim, Hiemenz John, Brown Randall, Cogle Christopher, Wingard John R, Hsu Jack W
Division of Hematology/Oncology, University of Florida, Gainesville, Florida.
Division of Hematology/Oncology and Vanderbilt Ingram Comprehensive Cancer Center, Vanderbilt University, Nashville, Tennessee.
J Clin Apher. 2018 Feb;33(1):29-37. doi: 10.1002/jca.21556. Epub 2017 May 29.
Peripheral blood stem cell (PBSC) mobilization is routinely undertaken prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). A number of studies have identified risk factors for poor PBSC mobilization, however, little data exists to correlate mobilization with disease-specific outcomes in this patient population. Prospective work in MM has demonstrated similar outcomes in a homogenous patient population.
In this single institution analysis, we retrospectively studied the impact of poor PBSC mobilization on progression free survival (PFS) and OS in MM patients undergoing PBSC mobilization. Poor mobilizers are defined as patients that collected < 4 × 10 CD34 cells/kg over maximum of 5 apheresis days, or those that required ≥2 mobilization cycles to achieve this target.
We confirm that poor PBSC mobilization is significantly associated with a shortened PFS (P = .0012) and OS (P = .0005) compared with good mobilizers. Our univariate analysis also shows that independent risk factors for poor mobilization include male gender, higher ideal body weight, and a greater median number of lines of chemotherapy prior to PBSC mobilization. However, by multivariate analysis, only number of prior lines of chemotherapy remains significantly predictive of poor mobilization (Odds ratio 1.857, P = .0095). The use of high-dose G-CSF (> 10 mcg/kg/day) and/or plerixafor can significantly improve mobilization and ASCT chances in this population.
These data indicate that poor mobilization can be predictable and is associated with more aggressive disease biology and worse outcomes, warranting intensive post-ASCT management.
在多发性骨髓瘤（MM）患者进行自体干细胞移植（ASCT）之前，常规进行外周血干细胞（PBSC）动员。多项研究已确定PBSC动员不佳的风险因素，然而，在该患者群体中，将动员与疾病特异性结局相关联的数据很少。MM的前瞻性研究表明，在同质患者群体中结局相似。
在这项单机构分析中，我们回顾性研究了PBSC动员不佳对接受PBSC动员的MM患者无进展生存期（PFS）和总生存期（OS）的影响。动员不佳者定义为在最多5个单采血浆术日收集的CD34细胞<4×10⁶/kg的患者，或那些需要≥2个动员周期才能达到该目标的患者。
我们证实，与动员良好者相比，PBSC动员不佳与PFS缩短（P = 0.0012）和OS缩短（P = 0.0005）显著相关。我们的单因素分析还表明，动员不佳的独立危险因素包括男性、较高的理想体重以及PBSC动员前化疗线数的中位数较多。然而，通过多因素分析，只有先前化疗线数仍然是动员不佳的显著预测因素（优势比1.857，P = 0.0095）。使用高剂量G-CSF（>10 mcg/kg/天）和/或普乐沙福可显著改善该人群的动员和ASCT机会。
这些数据表明，动员不佳是可预测的，并且与更具侵袭性的疾病生物学和更差的结局相关，需要在ASCT后进行强化管理。
