Cai Hao, Bai Jiefei, Li Jian, Cai Huacong, Duan Minghui, Cao Xinxin, Chen Miao, Zhou Daobin, Zhang Wei
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Arch Med Sci. 2018 Aug;14(5):1048-1054. doi: 10.5114/aoms.2016.63353. Epub 2016 Nov 2.
Lenalidomide is an effective therapy of POEMS syndrome. However, there is concern that exposure to lenalidomide may reduce the efficiency of blood cell collection in persons who may eventually receive an autotransplant. We studied the impact of lenalidomide therapy on subsequent blood cell mobilization and collection including frequency of blood CD34+ cells and CXCR4 expression before and after mobilization with cyclophosphamide and granulocyte-colony stimulating factor (G-CSF).
Forty-three subjects with POEMS were assigned to receive lenalidomide and dexamethasone for 2-4 28 d cycles ( = 19) or no therapy ( = 24). All subjects then received cyclophosphamide and G-CSF. Neither cohort had substantial numbers of blood CD34+ cells before mobilization.
Mobilization increased blood CD34+ frequency in lenalidomide-treated subjects and controls similarly (0.25% (95% confidence interval (CI): 0.03-1.39% vs. 0.32%, 0.04-1.47%), = 0.472). Increases in blood CD34+ numbers were also similar (10 × 10/l) (5-77 × 10/l) vs. 14 × 10/l (6-101 × 10/l), = 0.312). Mean CXCR4 fluorescence intensity on bone marrow cells from controls decreased from 58 ±34 (mean ± SD) to 31 ±16 after mobilization ( = NS). In contrast, mean CXCR4 intensity on bone marrow cells in lenalidomide-treated subjects increased from 55 ±43 to 89 ±40 ( = 0.017, comparing the deviation between two groups). Median numbers of CD34+ cells collected in lenalidomide-treated subjects and controls were 2.3 × 10/kg (0.6-6.8 × 10/kg) and 2.810/kg (1.0-8.9 × 10/kg; = 0.521).
Brief lenalidomide treatment for POEMS did not reduce numbers of CD34+ blood cells collected but increased CXCR4 expression on bone marrow CD34+ cells.
来那度胺是治疗POEMS综合征的一种有效疗法。然而，有人担心使用来那度胺可能会降低最终可能接受自体移植者的血细胞采集效率。我们研究了来那度胺治疗对随后血细胞动员和采集的影响，包括在使用环磷酰胺和粒细胞集落刺激因子（G-CSF）动员前后血液CD34+细胞的频率和CXCR4表达。
43例POEMS患者被分配接受来那度胺和地塞米松治疗2 - 4个28天周期（n = 19）或不接受治疗（n = 24）。然后所有受试者接受环磷酰胺和G-CSF治疗。在动员前，两组的血液CD34+细胞数量均不多。
来那度胺治疗组和对照组的动员后血液CD34+频率增加情况相似（0.25%（95%置信区间（CI）：0.03 - 1.39%）对0.32%，0.04 - 1.47%），P = 0.472）。血液CD34+细胞数量的增加也相似（10×10⁶/l（5 - 77×10⁶/l）对14×10⁶/l（6 - 101×10⁶/l），P = 0.312）。对照组动员后骨髓细胞上的平均CXCR4荧光强度从58±34（平均值±标准差）降至31±16（P = 无显著性差异）。相比之下，来那度胺治疗组骨髓细胞上的平均CXCR4强度从55±43增加到89±40（P = 0.017，比较两组之间的差异）。来那度胺治疗组和对照组采集的CD34+细胞中位数分别为2.3×10⁶/kg（0.6 - 6.8×10⁶/kg）和2.8×10⁶/kg（1.0 - 8.9×10⁶/kg；P = 0.521）。
对POEMS进行短期来那度胺治疗不会减少采集的CD34+血细胞数量，但会增加骨髓CD34+细胞上的CXCR4表达。
