Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Transplant Cell Ther. 2022 Nov;28(11):754-759. doi: 10.1016/j.jtct.2022.08.017. Epub 2022 Aug 22.
A major barrier for proceeding to autologous stem cell transplantation (ASCT) is an inability to mobilize and collect an adequate number of peripheral blood (PB) stem cells (PBSC) for the transplant graft. Plerixafor added to granulocyte colony stimulating factor (G-CSF) alone, without prior chemotherapy, significantly improves the mobilization of autologous PBSC in patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). However, the efficacy of plerixafor and the best timing to give the drug to poorly mobilizing patients with very low PB CD34+ cell counts after salvage chemotherapy and G-CSF are not well defined. We hypothesized that PBSC mobilization and collection might be improved in heavily treated patients who mobilized very poorly after salvage chemotherapy and G-CSF by alternating the days of plerixafor administration and leukapheresis. A day of rest between plerixafor doses, while continuing G-CSF, could allow time for some replenishment of the marrow stem/progenitor cell pool before the next mobilization. A retrospective review of collection results in poorly mobilizing patients at our center was undertaken. Three cohorts were identified: those who got every-other-day plerixafor and leukapheresis, those who got sequential plerixafor and leukapheresis and those who got risk adapted plerixafor. Overall, 69% of patients with NHL and MM with PB CD34+ cell counts <5/µL after salvage chemotherapy and G-CSF were ultimately able to collect adequate CD34+ cells to support ASCT using daily plerixafor and leukapheresis. On the alternating plerixafor and leukapheresis schedule, all 17 patients achieved the cumulative CD34+ cell product goals required for ASCT. This positive observation after salvage chemotherapy and G-CSF led to the incorporation at our center of an alternate-day schedule of plerixafor and leukapheresis into our real-time risk adapted strategy for poor mobilizers. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
进行自体干细胞移植（ASCT）的一个主要障碍是无法动员和采集足够数量的外周血（PB）干细胞（PBSC）用于移植移植物。培非格司亭与粒细胞集落刺激因子（G-CSF）联合使用，无需预先进行化疗，可显著改善非霍奇金淋巴瘤（NHL）和多发性骨髓瘤（MM）患者的自体 PBSC 动员。然而，培非格司亭的疗效以及在挽救性化疗和 G-CSF 后 PB CD34+细胞计数极低的动员效果不佳的患者中给予该药的最佳时机尚不清楚。我们假设通过交替给予培非格司亭和白细胞分离术的天数，可以改善在挽救性化疗和 G-CSF 后动员效果极差的重度治疗患者的 PBSC 动员和采集。在给予培非格司亭剂量之间休息一天，同时继续给予 G-CSF，可能会在下次动员前为骨髓干细胞/祖细胞池的补充留出一些时间。我们对中心动员效果不佳的患者的采集结果进行了回顾性分析。确定了三个队列：接受每两天一次培非格司亭和白细胞分离术的患者、接受序贯培非格司亭和白细胞分离术的患者以及接受风险适应培非格司亭的患者。总体而言，69%的 NHL 和 MM 患者在挽救性化疗和 G-CSF 后 PB CD34+细胞计数<5/µL，最终能够使用每日培非格司亭和白细胞分离术采集足够的 CD34+细胞以支持 ASCT。在交替给予培非格司亭和白细胞分离术的方案中，所有 17 名患者均达到了 ASCT 所需的累积 CD34+细胞产物目标。这一在挽救性化疗和 G-CSF 后的积极观察结果导致我们中心将培非格司亭和白细胞分离术的隔日方案纳入我们针对动员效果不佳者的实时风险适应策略中。© 2023 美国血液和骨髓移植学会。由 Elsevier Inc. 出版，保留所有权利。
