Stanford Cancer Institute, Stanford, California; Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California.
Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California; Division of Hematology, University of Southern California, Los Angeles, California.
Transplant Cell Ther. 2021 Jul;27(7):590.e1-590.e8. doi: 10.1016/j.jtct.2021.04.016. Epub 2021 Apr 26.
Growth factor and chemotherapy-based stem cell mobilization strategies are commonly used to treat patients with multiple myeloma. We retrospectively compared 398 patients mobilized between 2017 and 2020 using either cyclophosphamide (4 g/m) plus granulocyte colony-stimulating factor (G-CSF) or G-CSF alone, with on demand plerixafor (PXF) in both groups. Although total CD34 yield was higher after chemomobilization compared with G-CSF +/- PXF (median, 13.6 × 10/kg versus 4.4 × 10/kg; P < .01), achievement of ≥2 × 10 CD34 cells (95% versus 93.7%; P = .61) and rates of mobilization failure (5% versus 6.3%; P = .61) were similar. Fewer patients required PXF with chemomobilization (12.3% versus 49.5%; P < .01), and apheresis sessions were fewer (median, 1 [range, 1 to 4] versus 2 [range, 1 to 5]). The rate of complications, including neutropenic fever, emergency department visits, and hospitalizations, was higher after chemomobilization (30% versus 7.4%; P < .01). Previous use of ≤6 cycles of lenalidomide did not impair cell yield in either group. The median cost of mobilization was 17.4% lower in the G-CSF +/- PXF group (P = .01). Between group differences in time to engraftment were not clinically significant. Given similar rates of successful mobilization, similar engraftment time, and less toxicity and lower costs compared with chemomobilization, G-CSF with on-demand PXF may be preferable in myeloma patients with adequate disease control and limited lenalidomide exposure.
生长因子和基于化疗的干细胞动员策略常用于治疗多发性骨髓瘤患者。我们回顾性比较了 2017 年至 2020 年期间使用环磷酰胺（4g/m）加粒细胞集落刺激因子（G-CSF）或 G-CSF 加按需培非格司亭（PXF）动员的 398 例患者。虽然与 G-CSF +/- PXF 相比，化疗动员后总 CD34 产量更高（中位数，13.6×10/kg 与 4.4×10/kg；P<0.01），但达到≥2×10 CD34 细胞（95%与 93.7%；P=0.61）和动员失败率（5%与 6.3%；P=0.61）相似。化疗动员中需要 PXF 的患者更少（12.3%与 49.5%；P<0.01），且采集次数更少（中位数，1 [范围，1 至 4] 与 2 [范围，1 至 5]）。化疗动员后并发症（包括中性粒细胞减少性发热、急诊就诊和住院）发生率更高（30%与 7.4%；P<0.01）。两组中，既往使用≤6 个周期来那度胺均未影响细胞产量。G-CSF +/- PXF 组动员费用中位数降低 17.4%（P=0.01）。两组间植入时间差异无临床意义。与化疗动员相比，G-CSF 加按需 PXF 可获得相似的动员成功率、相似的植入时间、更低的毒性和更低的成本，尤其适用于疾病控制良好且来那度胺暴露有限的多发性骨髓瘤患者。
