Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, China.
State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China.
Ann Hematol. 2020 Jun;99(6):1331-1339. doi: 10.1007/s00277-019-03800-0. Epub 2020 May 8.
Autologous stem cell transplantation (ASCT) is the only curable therapy for multiple myeloma (MM), while its success primarily relies on mobilization to obtain sufficient hematopoietic stem/progenitor cells (HPC). Although the role of Pegfilgrastim (PEG), a novel PEGylated form of the recombinant G-CSF filgrastim (FIL), in mobilization has been demonstrated, it remains unclear whether this approach is cost-effective in MM treatment. Here, we performed a real-world analysis to evaluate the efficacy and cost of PEG for mobilization in a cohort of MM patients, of which 53% carried high-risk cytogenetic abnormalities. A total of 91 patients who received either a single dose of PEG (6 or 12 mg, n = 42) or multiple dosing of 10 μg/kg/day FIL (n = 49) after chemotherapy for HPC mobilization were included. The yield of MNCs and CD34 cells per milliliter of blood collected via apheresis was significantly greater in the PEG group than that in the FIL group (P = 0.014 and P = 0.038). Mobilization with PEG yielded significantly higher median number of collected CD34 cells than FIL (5.56 vs. 4.82 × 10/kg; P = 0.038). Moreover, the average time-to-recovery of leukocytes and platelets after transplantation was markedly shorter in the PEG group than that in the FIL group (leukocyte, 11.59 ± 1.98 vs 12.93 ± 2.83 days, P = 0.019; platelet, 12.86 ± 2.62 vs 14.80 ± 5.47, P = 0.085). However, the total cost of mobilization and apheresis using PEG or FIL was comparable (P = 0.486). Of note, mobilization with 12 mg PEG further shortened time-to-recovery of leukocytes (10.64 ± 0.51 vs. 12.04 ± 2.26 days, P = 0.05) and platelets (10.60 ± 2.89 vs. 13.33 ± 2.35 days, P = 0.031) compared with 6 mg PEG. Our results support a notion that PEG (especially 12 mg) combined with chemotherapy is a cost-effective and convenient regimen of mobilization, which might improve the outcome of ASCT in MM.
自体干细胞移植（ASCT）是多发性骨髓瘤（MM）唯一可治愈的疗法，而其成功主要依赖于动员以获得足够的造血干细胞/祖细胞（HPC）。虽然已证明 Pegfilgrastim（PEG），即重组 G-CSF filgrastim（FIL）的新型 PEG 化形式，在动员中的作用，但在 MM 治疗中，这种方法是否具有成本效益仍不清楚。在这里，我们进行了一项真实世界的分析，以评估 PEG 在接受化疗动员 HPC 的 MM 患者队列中的疗效和成本，其中 53%的患者具有高风险细胞遗传学异常。共有 91 名患者接受了单剂量 PEG（6 或 12 mg，n = 42）或 10 μg/kg/天 FIL 的多次剂量（n = 49）动员。通过单采术采集的每毫升血液中 MNC 和 CD34 细胞的产量在 PEG 组显著高于 FIL 组（P = 0.014 和 P = 0.038）。PEG 动员产生的 CD34 细胞中位数量明显高于 FIL（5.56 与 4.82×106/kg；P = 0.038）。此外，PEG 组白细胞和血小板移植后恢复的平均时间明显短于 FIL 组（白细胞，11.59 ± 1.98 与 12.93 ± 2.83 天，P = 0.019；血小板，12.86 ± 2.62 与 14.80 ± 5.47，P = 0.085）。然而，使用 PEG 或 FIL 进行动员和单采的总费用相当（P = 0.486）。值得注意的是，12 mg PEG 动员进一步缩短了白细胞（10.64 ± 0.51 与 12.04 ± 2.26 天，P = 0.05）和血小板（10.60 ± 2.89 与 13.33 ± 2.35 天，P = 0.031）的恢复时间与 6 mg PEG 相比。我们的结果支持一种观点，即 PEG（特别是 12 mg）联合化疗是一种具有成本效益和方便的动员方案，可能会改善 MM 患者 ASCT 的结果。
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