南非中心血液系统恶性肿瘤患者造血干细胞动员不良的预测因素。

Predictors of poor haematopoietic stem cell mobilisation in patients with haematological malignancies at a South African centre.

机构信息

Cellular and Immunotherapy Centre, Wits Donald Gordon Medical Centre, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Department of Internal medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.

出版信息

Transfus Apher Sci. 2022 Aug;61(4):103419. doi: 10.1016/j.transci.2022.103419. Epub 2022 Mar 3.

DOI:10.1016/j.transci.2022.103419

PMID:35288051

Abstract

BACKGROUND

Autologous stem cell transplant (ASCT) is an established consolidation strategy in the treatment of haematological malignancies, however poor mobilisation (PM) can contribute to patient morbidity and high resource utilisation. Identifying the incidence, risk factors for PM and engraftment outcomes are important goals in our resource limited setting.

METHODS

We retrospectively analyzed patients with haematological malignancies that consecutively underwent ASCT at Groote Schuur hospital, Cape Town, South Africa from January 2013 to January 2019.

RESULTS

146 patients - majority with multiple myeloma (MM)(41,8%), F:M= 1:2, underwent leukapheresis with median age of 32 years (range, 9 - 66 years). PM occurred in 25/146 (17%), mobilisation failure (MF) in 3/146 (2%) and super mobilisation (SMs) in 99/146 (68%), respectively. Risk factors for PM were: diagnosis of acute leukaemia (RR = 25, 95% CI 3.4 - 183, p = 0.002) and Hodgkin lymphoma (RR = 19, 95% CI 2.6 - 142, p = 0.004); low white cell count (WCC) at harvest (WCC < 9 × 10/L (RR=4.3, 95% CI 2.3 - 8.3, p < 0.0001) and two vs one line of prior therapy (RR = 3.1, 95% CI 1.45 - 6.7, p = 0.0037). Median days to neutrophil and platelet engraftment were 14 days (95% CI 14-15 days) and 16 days (95% CI 15-16 days) respectively.

CONCLUSION

PM occurred in 17% of a contemporary South African ASCT cohort, albeit with a low MF rate (2%). There was surprisingly high rate (68%) of SMs, possibly reflective of superfluous mobilisation strategy in MM patients. We identified predictive factors for PM that will lead to enhanced cost-effective use of plerixafor.

摘要

背景

自体干细胞移植（ASCT）是血液系统恶性肿瘤治疗中一种既定的巩固策略，然而，动员不良（PM）可能导致患者发病率和高资源利用。在我们资源有限的环境中，确定 PM 的发生率、PM 的风险因素和植入结果是重要的目标。

方法

我们回顾性分析了 2013 年 1 月至 2019 年 1 月在南非开普敦格罗特舒尔医院连续接受 ASCT 的血液系统恶性肿瘤患者。

结果

146 例患者-大多数为多发性骨髓瘤（MM）（41.8%），男女比例为 1:2，中位年龄为 32 岁（范围为 9-66 岁），接受白细胞分离术。146 例患者中，PM 发生率为 25/146（17%），动员失败（MF）发生率为 3/146（2%），超动员（SMs）发生率为 99/146（68%）。PM 的危险因素包括：急性白血病诊断（RR=25，95%CI 3.4-183，p=0.002）和霍奇金淋巴瘤（RR=19，95%CI 2.6-142，p=0.004）；收获时白细胞计数（WCC）低（WCC<9×10/L（RR=4.3，95%CI 2.3-8.3，p<0.0001）和两线与一线既往治疗（RR=3.1，95%CI 1.45-6.7，p=0.0037）。中性粒细胞和血小板植入的中位天数分别为 14 天（95%CI 14-15 天）和 16 天（95%CI 15-16 天）。