Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Internal Medicine III, University of Munich, Munich, Germany.
Bone Marrow Transplant. 2019 Jan;54(1):123-129. doi: 10.1038/s41409-018-0228-z. Epub 2018 May 24.
Mobilization and collection of peripheral blood stem cells is part of the standard treatment procedure for non-Hodgkin's lymphoma patients eligible for high-dose chemotherapy with autologous stem cell transplantation. Mobilization is usually achieved with chemotherapy and/or cytokines, but plerixafor might be added in case of poor mobilization. Due to the high cost several institutions have developed their own management pathway to optimize use of plerixafor. Such models are however rarely generalizable; in a multi-center, European, non-interventional study, evaluating the impact of plerixafor in poor mobilizers, country specific differences in patient treatment and cost structure were obvious. For German centers, there was a non-significant reduction in the number of apheresis sessions carried out and in apheresis costs. In contrast to other European countries the majority of German Plerixafor patients were very poor mobilizing patients with initial CD34+ cell count ≤ 10/µl (40/51). In this group the number of apheresis sessions decreased from 2.1 to 1.6 sessions per patient (p = 0.01) and costs decreased from €6246 to €4758 (p = 0.01). Our results show that preemptive plerixafor use has a strong effect in poor mobilizers with an initial CD34+ cell count ≤ 10 cells/µl.
动员和采集外周血干细胞是适合接受自体干细胞移植的高剂量化疗的非霍奇金淋巴瘤患者的标准治疗程序的一部分。动员通常通过化疗和/或细胞因子来实现，但如果动员效果不佳，可以添加培西洛沙福。由于成本高昂，许多机构已经开发出自己的管理途径，以优化培西洛沙福的使用。然而，这些模型很少具有通用性；在一项评估培西洛沙福对动员不良患者的影响的多中心、欧洲、非干预性研究中，明显存在患者治疗和成本结构的国家特定差异。对于德国中心，进行的单采次数和单采成本均有非显著减少。与其他欧洲国家相比，大多数德国培西洛沙福患者是初始 CD34+细胞计数≤10/µl 的非常差的动员患者（40/51）。在该组中，每位患者的单采次数从 2.1 次减少到 1.6 次（p=0.01），成本从€6246 减少到€4758（p=0.01）。我们的结果表明，在初始 CD34+细胞计数≤10 个细胞/µl 的动员不良患者中，预防性使用培西洛沙福具有很强的效果。
