Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Transplant Cell Ther. 2021 Aug;27(8):661.e1-661.e6. doi: 10.1016/j.jtct.2021.04.010. Epub 2021 Apr 22.
Since the introduction of lenalidomide into induction therapy for multiple myeloma (MM), there have been conflicting reports about its impact on autologous peripheral blood stem cell (PBSC) mobilization. We evaluated the impact of previous lenalidomide exposure in a large cohort of patients with MM undergoing mobilization and collection at a tertiary stem cell transplantation center. We hypothesized that collection of PBSCs is feasible even with a prolonged duration of previous lenalidomide therapy. We examined patients with MM who attempted stem cell mobilization and collection, seen at our center between January 2012 and July 2015. The patients were categorized into 3 groups for analysis: (1) patients with previous receipt of >6 cycles lenalidomide, (2) patients with previous receipt of ≤6 cycles of lenalidomide, and (3) patients without previous lenalidomide exposure. We compared collection yields and days of apheresis among the 3 groups using linear regression analysis. We identified 297 patients with MM who underwent mobilization of PBSCs. Of these, 35 had received >6 cycles of lenalidomide (median, 8 cycles; range, 7 to 25 cycles), 156 had received ≤6 cycles of lenalidomide (median, 4 cycles; range, 1 to 6 cycles), and 106 had received no lenalidomide. Prior lenalidomide exposure did not have a statistically significant impact on the absolute number of CD34 cells collected or on the duration of collection based on a multivariate linear regression analysis for association between receipt of >6 cycles of lenalidomide. In this retrospective analysis of MM patients undergoing autologous PBSC transplantation, we show that the duration of previous lenalidomide exposure does not impact the total number of PBSCs collected or the number of days of apheresis. These data suggest that longer courses of induction therapy with lenalidomide-containing regimens to achieve a maximum response can be safe without impairing the ability to collect PBSCs, and that limiting lenalidomide use before mobilization does not appear warranted in all cases.
自来那度胺用于多发性骨髓瘤（MM）的诱导治疗以来，关于其对自体外周血造血干细胞（PBSC）动员的影响存在相互矛盾的报告。我们在一个三级干细胞移植中心对接受动员和采集的大量 MM 患者评估了先前来那度胺暴露的影响。我们假设，即使先前来那度胺治疗时间延长，PBSC 的采集也是可行的。我们检查了 2012 年 1 月至 2015 年 7 月在我们中心尝试干细胞动员和采集的 MM 患者。将患者分为 3 组进行分析：（1）先前接受 >6 个周期来那度胺治疗的患者，（2）先前接受 ≤6 个周期来那度胺治疗的患者，和（3）无先前来那度胺暴露的患者。我们使用线性回归分析比较了 3 组之间的采集产量和单采天数。我们确定了 297 名接受 PBSC 动员的 MM 患者。其中，35 名患者接受了 >6 个周期的来那度胺（中位数，8 个周期；范围，7 至 25 个周期），156 名患者接受了 ≤6 个周期的来那度胺（中位数，4 个周期；范围，1 至 6 个周期），106 名患者未接受来那度胺。基于多变量线性回归分析，先前接受来那度胺治疗与接受 >6 个周期来那度胺之间存在关联，来那度胺暴露对采集的 CD34 细胞绝对数量或采集时间无统计学显著影响。在这项对接受自体 PBSC 移植的 MM 患者的回顾性分析中，我们表明先前来那度胺暴露的持续时间不会影响采集的 PBSC 总数或单采天数。这些数据表明，为实现最大反应而使用包含来那度胺的方案进行更长时间的诱导治疗是安全的，而不会损害采集 PBSC 的能力，并且在所有情况下似乎都没有必要限制动员前的来那度胺使用。
