Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan.
Cytotherapy. 2022 Jan;24(1):49-58. doi: 10.1016/j.jcyt.2021.09.004. Epub 2021 Oct 12.
Predicting autologous peripheral blood stem cell (PBSC) collection yield before leukapheresis is important for optimizing PBSC mobilization and autologous stem cell transplantation (ASCT) for treating hematological malignancies. Although guidelines for plerixafor usage based on peripheral blood CD34 (PB-CD34) cell count are available, their predictive performance in the real world remains unclear.
This study retrospectively analyzed 55 mobilization procedures for patients with non-Hodgkin lymphoma or multiple myeloma and developed a novel quantitative prediction model for CD34 cell collection yield that incorporated four clinical parameters available the day before leukapheresis; namely, PB-CD34 cell count the day before apheresis (day -1 PB-CD34), number of prior chemotherapy regimens, disease status at apheresis and mobilization protocol.
The effects of PB-CD34 cell counts on CD34 cell collection yield varied widely per patient characteristics, and plerixafor usage was recommended in patients with poorly controlled disease or those with a history of heavy pre-treatments even with abundant day -1 PB-CD34 cell count. This model suggested a more proactive use of plerixafor than that recommended by the guidelines for patients with poor pre-collection condition or those with a higher target number of CD34 cells. Further, the authors analyzed the clinical outcomes of ASCT and found that plerixafor use for stem cell mobilization did not affect short- or long-term outcomes after ASCT.
Although external validations are necessary, the results can be beneficial for establishing more effective and safer mobilization strategies.
在白细胞分离术之前预测自体外周血干细胞（PBSC）采集量对于优化 PBSC 动员和自体干细胞移植（ASCT）治疗血液系统恶性肿瘤非常重要。尽管已有基于外周血 CD34（PB-CD34）细胞计数的培利珠单抗使用指南，但它们在实际中的预测性能仍不清楚。
本研究回顾性分析了 55 例非霍奇金淋巴瘤或多发性骨髓瘤患者的动员程序，并开发了一种新的 CD34 细胞采集量定量预测模型，该模型纳入了白细胞分离术前一天的四个临床参数；即白细胞分离术前一天的 PB-CD34 细胞计数（day -1 PB-CD34）、先前化疗方案的数量、白细胞分离术时的疾病状态和动员方案。
PB-CD34 细胞计数对 CD34 细胞采集量的影响因患者特征而异，即使 PB-CD34 细胞计数丰富，也建议在疾病控制不佳或有大量预处理史的患者中使用培利珠单抗。与指南推荐的方案相比，该模型建议对采集前条件较差或目标 CD34 细胞数量较高的患者更积极地使用培利珠单抗。此外，作者分析了 ASCT 的临床结局，发现干细胞动员中使用培利珠单抗不会影响 ASCT 后的短期或长期结局。
尽管需要进行外部验证，但这些结果有助于制定更有效和更安全的动员策略。
