Goker Hakan, Ciftciler Rafiye, Demiroglu Haluk, Turgut Mehmet, Sayınalp Nilgun, Haznedaroglu I C, Okay Mufide, Tekin Fatma, Buyukasık Yahya
Hacettepe University, School of Medicine, Department of Hematology, Ankara, Turkey.
Hacettepe University, School of Medicine, Department of Hematology, Ankara, Turkey.
Transfus Apher Sci. 2020 Feb;59(1):102595. doi: 10.1016/j.transci.2019.06.023. Epub 2019 Aug 8.
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been considered the standard of treatment care for patients with multiple myeloma (MM). Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. This is resulting in a lacking opportunity of cure in patients with MM. The aim of this study was to evaluate the factors which influence mobilization failure in patients with MM.
This study has been performed in a retrospective manner. Two hundred and thirty-four patients with diagnosed MM who underwent stem cell mobilization after induction chemotherapy at Hacettepe University Hospital between the years of 2003 and 2018 were evaluated.
A total of 234 patients were included in this study. The median age was 54 (32-76) years at the time of diagnosis. In 209 of 234 patients (89.3%) first mobilization trial was successful. At univariate analysis, among parameters identifiable before mobilization, male gender (p = 0.03), number of chemotherapy cycle before stem cell mobilization (p < 0.001), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p < 0.001) predicted mobilization failure. At multivariate analysis, number of chemotherapy cycle before stem cell mobilization (p = 0.03), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p = 0.02) retained independent predictive power.
Detectable different clinical characteristics of MM patients before initiating mobilization may be predictors of poor mobilization. Therefore, the mobilization protocol should be evaluated on a patient basis. Minimization of exposure to chemotheraputic agents in MM patients, especially immunomodulatory agents, may increase CD34+ cell harvest yields.
大剂量化疗后行自体干细胞移植（ASCT）一直被视为多发性骨髓瘤（MM）患者的标准治疗方案。外周干细胞动员不足和采集量不足可能是进行ASCT的主要障碍。这导致MM患者缺乏治愈机会。本研究旨在评估影响MM患者动员失败的因素。
本研究采用回顾性研究方法。对2003年至2018年间在哈杰泰佩大学医院接受诱导化疗后进行干细胞动员的234例确诊MM患者进行了评估。
本研究共纳入234例患者。诊断时的中位年龄为54（32 - 76）岁。234例患者中有209例（89.3%）首次动员试验成功。单因素分析显示，在动员前可识别的参数中，男性（p = 0.03）、干细胞动员前化疗周期数（p < 0.001）、第二次ASCT（p < 0.001）以及干细胞动员前的免疫调节治疗（p < 0.001）可预测动员失败。多因素分析显示，干细胞动员前化疗周期数（p = 0.03）、第二次ASCT（p < 0.001）以及干细胞动员前的免疫调节治疗（p = 0.02）仍具有独立预测能力。
MM患者在开始动员前可检测到的不同临床特征可能是动员不佳的预测因素。因此，应根据患者个体情况评估动员方案。尽量减少MM患者尤其是免疫调节药物的化疗药物暴露，可能会提高CD34 +细胞采集量。
