普乐沙福按需联合低剂量环磷酰胺和粒细胞集落刺激因子用于多发性骨髓瘤患者的动员：高效、低毒且成本可承受。

Plerixafor on-demand in association with low-dose cyclophosphamide and G-CSF in the mobilization of patients with multiple myeloma: High effectiveness, low toxicity, and affordable cost.

作者信息

Milone Giuseppe, Conticello Concetta, Leotta Salvatore, Michieli Maria Grazia, Martino Massimo, Marco Anna Lia Di, Spadaro Andrea, Cupri Alessandra, Condorelli Annalisa, Milone Giulio Antonio, Markovic Uros, Sciortino Roberta, Schininà Giovanni, Moschetti Gaetano, Villari Loredana, Saccardi Riccardo

机构信息

Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy.

IRCCS CRO Aviano, High dose Chemotherapy and BMT Unit, Aviano, Italy.

出版信息

Leuk Res Rep. 2020 Oct 30;14:100227. doi: 10.1016/j.lrr.2020.100227. eCollection 2020.

DOI:10.1016/j.lrr.2020.100227

PMID:33204611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7649636/

Abstract

In CD34+ cells mobilization of patients with multiple myeloma (MM), the use of Cyclophosphamide (CTX) at a dose of 2 g/m has low efficacy although also lower toxicity. The suboptimal mobilizing effect of low-dose CTX, however, may be overcome by plerixafor (PLX) on demand. We conducted a prospective multicenter study in 138 patients with MM to evaluate CTX 2 g/m in association with granulocyte-colony stimulating factor (G-CSF) and on-demand PLX. We compared results with a historical group of MM patients (n = 138) mobilized using CTX at a dose of 4 g/m. CD34+ cells greater than 2 × 10/kg in max three aphereses were harvested in 98.6% of patients in the on-demand PLX study group while in 84.0% in the historical group, (p = 0.0001). In the on-demand-PLX study group, a successful harvest greater than 5 × 10/kg in max three aphereses was observed in 85.5% of patients versus 62.3% of patients in the historical control group, (p=0.0001). In the on-demand-PLX study group, 4.3% (6/138) of patients had febrile complications. Salvage mobilization in the on-demand PLX study group was 1.4%. In conclusions, on-demand PLX + CTX 2 g/m2 + G-CSF 10 μg/kg has higher efficacy and lower toxicity compared with CTX 4 g/m2 + G-CSF. An analysis of costs is presented.

摘要

在多发性骨髓瘤（MM）患者的CD34+细胞动员中，使用剂量为2 g/m²的环磷酰胺（CTX）疗效较低，不过毒性也较低。然而，低剂量CTX的动员效果欠佳，可通过按需使用普乐沙福（PLX）来克服。我们对138例MM患者进行了一项前瞻性多中心研究，以评估2 g/m² CTX联合粒细胞集落刺激因子（G-CSF）和按需使用PLX的情况。我们将结果与一组使用4 g/m² CTX进行动员的MM患者历史队列（n = 138）进行了比较。按需使用PLX研究组中，98.6%的患者在最多三次单采中收获的CD34+细胞大于2×10⁶/kg，而历史队列组中这一比例为84.0%，（p = 0.0001）。在按需使用PLX研究组中，85.5%的患者在最多三次单采中成功收获的细胞大于5×10⁶/kg，而历史对照组中这一比例为62.3%的患者，（p = 0.0001）。在按需使用PLX研究组中，4.3%（6/138）的患者出现发热并发症。按需使用PLX研究组的挽救性动员率为1.4%。总之，与4 g/m² CTX + G-CSF相比，按需使用PLX + 2 g/m² CTX + 10 μg/kg G-CSF具有更高的疗效和更低的毒性。本文还进行了成本分析。