Zhu Zhijuan, Li Xiaofan, Liu Yiping, Chen Ping, Chen Xianling, Li Hua, Huang Jiafu, Chen Yuanzhong, Li Nainong
Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
Translational Medicine Center on Hematology, Fujian Medical University, Fuzhou, China.
Front Oncol. 2022 Jan 27;12:825550. doi: 10.3389/fonc.2022.825550. eCollection 2022.
Efficient mobilization of CD34+ hematopoietic stem cells plays a vital role in successful autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM), especially in cases with high-risk cytogenetic recommended for tandem ASCT. However, the optimal mobilization strategy remains a matter of debate in the era of lenalidomide. The combination of etoposide with Cytarabine plus G-CSF as a novel mobilization regimen in MM has not been reported previously.
This research retrospectively studied mobilization efficacy and safety using etoposide combined with Cytarabine (etoposide 50-100 mg/m, qd d1-3; AraC 0.5 g/m, q12h d1~3) plus G-CSF (5 µg/kg/day, from d5 until the day of apheresis) in 128 patients with MM. 70(54.7%) patients received lenalidomide-based induction regimens treatment.
A median of 27.75×10 CD34+ cells/kg was collected in the first apheresis, and 28.23×10 CD34+ cells/kg were collected overall. Of the 128 patients, all achieved adequate collection (≥2×10 CD34+ cells/kg), 121(94.5%) achieved optimal collection for single ASCT (≥5×10 CD34+ cells/kg), and 114(89.1%) harvested optimal collection for tandem ASCT (≥10×10 CD34+ cells/kg). In particular, the target yield of optimal collection for tandem ASCT was reached in 82.8% (106/128) by a single apheresis procedure. 14 patients obtained deeper response post mobilization. In multivariate analysis, cycles of prior chemotherapy independently affected the optimal achievement of CD34+ cells (=0.004, OR 0.695, 95% CI 0.544~0.888). Previous lenalidomide exposure did not significantly impair CD34+ cells collection. Although 68% episodes of antibiotic usage were observed, no severe infection or treatment-related mortality occurred.
Stem cell mobilization with Etoposide + Cytarabine plus G-CSF was highly efficient and safe in patients with MM, which could be considered in high-risk MM patients who were referred for tandem ASCT.
在多发性骨髓瘤（MM）患者的自体干细胞移植（ASCT）成功实施过程中，CD34+造血干细胞的有效动员起着至关重要的作用，尤其是在推荐进行串联ASCT的高危细胞遗传学病例中。然而，在来那度胺时代，最佳动员策略仍是一个有争议的问题。依托泊苷联合阿糖胞苷加粒细胞集落刺激因子（G-CSF）作为MM患者一种新的动员方案，此前尚未见报道。
本研究回顾性分析了128例MM患者使用依托泊苷联合阿糖胞苷（依托泊苷50 - 100mg/m²，每日1次，第1 - 3天；阿糖胞苷0.5g/m²，每12小时1次，第1 - 3天）加G-CSF（5μg/kg/天，从第5天至采集日）进行动员的疗效和安全性。70例（54.7%）患者接受过来那度胺为基础的诱导方案治疗。
首次采集时，中位采集量为27.75×10⁶个CD34+细胞/kg，总体采集量为28.23×10⁶个CD34+细胞/kg。128例患者均实现了充足采集（≥2×10⁶个CD34+细胞/kg），121例（94.5%）实现了单次ASCT的最佳采集（≥5×10⁶个CD34+细胞/kg），114例（89.1%）实现了串联ASCT的最佳采集（≥10×10⁶个CD34+细胞/kg）。特别是，通过单次采集程序，82.8%（106/128）的患者达到了串联ASCT最佳采集的目标产量。14例患者在动员后获得了更深的缓解。多因素分析显示，既往化疗周期独立影响CD34+细胞的最佳采集成功率（P = 0.004，OR 0.695，95%CI 0.544 - 0.888）。既往使用过来那度胺并未显著影响CD34+细胞的采集。虽然观察到68%的患者有抗生素使用情况，但未发生严重感染或治疗相关死亡。
依托泊苷 + 阿糖胞苷加G-CSF进行干细胞动员在MM患者中高效且安全，对于推荐进行串联ASCT的高危MM患者可以考虑使用。
