输注血造血干细胞中冻存的 CD34 细胞数量对自体造血干细胞移植后骨髓瘤患者血液学恢复和生存的影响：GOA 研究的经验。

Impact of the number of cryopreserved CD34 cells in the infused blood grafts on hematologic recovery and survival in myeloma patients after autologous stem cell transplantation: Experience from the GOA study.

机构信息

Department of Medicine, Kuopio University Hospital, Kuopio, Finland.

Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

出版信息

J Clin Apher. 2023 Feb;38(1):33-44. doi: 10.1002/jca.22022. Epub 2022 Oct 14.

DOI:10.1002/jca.22022

PMID:36239392

Abstract

BACKGROUND

Prospective data on the impact of CD34 cell loss during cryopreservation and the amount of cryopreserved CD34 cells infused after high-dose therapy on hematologic recovery and post-transplant outcome in multiple myeloma (MM) are scarce.

PATIENTS AND METHODS

This post-hoc study aimed to investigate factors associating with CD34 cell loss during cryopreservation and the effects of the infusion of a very low number (<1.0 × 10 /kg, group A), low number (1-1.9 × 10 /kg, group B), and optimal number (≥2 × 10 /kg, group C) of thawed viable CD34 cells on hematologic recovery, progression free survival, and overall survival after autologous stem cell transplantation among 127 patients with MM.

RESULTS

In group C, pegfilgrastim use (P = 0.001), plerixafor use (P = 0.039), and older age ≥ 60 years (P = 0.026) were associated with less loss of CD34 cells during cryopreservation. Better mobilization efficacy correlated with greater CD34 cell loss in group B (P = 0.013 and P = 0.001) and in group C (P < 0.001 and P < 0.001). Early platelet engraftment was slowest in group A (20 d vs 12 d in group B vs 11 d in group C, P = 0.003). The infused viable CD34 cell count <1.0 × 10 /kg seemed not to have influence on PFS (P = 0.322) or OS (P = 0.378) in MM patients.

CONCLUSIONS

Cryopreservation impacts significantly on the CD34 cell loss. A very low number of graft viable CD34 cells did not affect PFS or OS.

摘要

背景

关于在冷冻保存过程中 CD34 细胞损失以及在高剂量治疗后输注的冷冻保存 CD34 细胞数量对多发性骨髓瘤（MM）患者血液学恢复和移植后结果的影响，目前缺乏前瞻性数据。

患者和方法

本研究旨在探讨与冷冻保存过程中 CD34 细胞损失相关的因素，以及输注非常少量（<1.0×10 /kg，A 组）、少量（1-1.9×10 /kg，B 组）和最佳数量（≥2×10 /kg，C 组）解冻有活力的 CD34 细胞对 127 例 MM 患者自体干细胞移植后血液学恢复、无进展生存期和总生存期的影响。

结果

在 C 组中，使用培非格司亭（P=0.001）、使用普乐沙福（P=0.039）和年龄较大（≥60 岁）（P=0.026）与冷冻保存过程中 CD34 细胞损失较少有关。在 B 组（P=0.013 和 P=0.001）和 C 组（P<0.001 和 P<0.001）中，更好的动员效果与更大的 CD34 细胞损失相关。A 组的早期血小板植入最慢（20 d 比 B 组 12 d，比 C 组 11 d，P=0.003）。在 MM 患者中，输注的有活力的 CD34 细胞计数<1.0×10 /kg 似乎对 PFS（P=0.322）或 OS（P=0.378）没有影响。