Department of Hematology, Oncology and Rheumatology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany.
BMC Cancer. 2020 Apr 25;20(1):353. doi: 10.1186/s12885-020-06873-7.
High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. However, the collection of sufficient peripheral blood stem cell (PBSC) grafts can be challenging, and the question arises whether reinfusion of low-dose grafts will lead to a hematopoietic recovery.
The hematopoietic recovery of 148 MM patients who underwent HD melphalan chemotherapy and received PBSC transplants with varying CD34+ cells doses (3-4 × 10 [n = 86], 2-2.5 × 10 [n = 53], < 2 × 10 [n = 9] per kg body weight [bw]) was analyzed in this retrospective single-center study.
All patients reached hematopoietic reconstitution, even those who received < 2 × 10 CD34+ cells/kg bw. 62 (42%) patients received granulocyte-colony-stimulating factor (G-CSF). The median duration to leukocyte recovery ≥1.0 × 10/L was 12 days in every group. The median duration to platelet recovery ≥20 × 10/L was 11, 13 and 13 days, respectively. In the multivariate analysis, a low number of reinfused CD34+ cells was associated with prolonged time until leukocyte reconstitution (p = 0.010, HR 0.607) and platelet recovery (p < 0.001, HR 0.438). G-CSF support significantly accelerated leukocyte (p < 0.001, HR 16.742) but not platelet reconstitution.
In conclusion, reinfusion of low- and even very-low-dose PBSC grafts leads to sufficient hematopoietic reconstitution. No severe adverse events were observed during or after HD chemotherapy and ASCT in the analyzed cohort. While the impact of CD34+ cell dose is marginal, G-CSF significantly accelerates the leukocyte recovery.
大剂量（HD）化疗后自体造血干细胞移植（ASCT）是多发性骨髓瘤（MM）患者的标准治疗方法。然而，采集足够的外周血造血干细胞（PBSC）移植物可能具有挑战性，并且会出现这样的问题，即输注低剂量移植物是否会导致造血恢复。
本回顾性单中心研究分析了 148 例接受 HD 美法仑化疗和不同 CD34+细胞剂量（3-4×10[n=86]、2-2.5×10[n=53]、<2×10[n=9]每公斤体重[bw]）PBSC 移植的 MM 患者的造血恢复情况。
所有患者均达到造血重建，甚至那些接受<2×10 CD34+细胞/kg bw 的患者也是如此。62（42%）例患者接受了粒细胞集落刺激因子（G-CSF）治疗。白细胞恢复至≥1.0×10/L 的中位时间在每组均为 12 天。血小板恢复至≥20×10/L 的中位时间分别为 11、13 和 13 天。在多变量分析中，输注的 CD34+细胞数量较少与白细胞重建时间延长相关（p=0.010，HR 0.607）和血小板恢复（p<0.001，HR 0.438）。G-CSF 支持显著加速白细胞（p<0.001，HR 16.742）但不加速血小板恢复。
总之，输注低剂量甚至极低剂量 PBSC 移植物可导致充分的造血重建。在分析的队列中，在 HD 化疗和 ASCT 期间或之后未观察到严重不良事件。虽然 CD34+细胞剂量的影响是微小的，但 G-CSF 显著加速了白细胞的恢复。
