淋巴瘤患者中动员不佳者而非骨髓瘤患者在自体干细胞移植后无进展生存期显著更差:一项大型回顾性单中心观察性研究的结果

Poor Mobilizers in Lymphoma but Not Myeloma Patients Had Significantly Poorer Progression-Free Survival after Autologous Stem Cell Transplantation: Results of a Large Retrospective, Single-Center Observational Study.

作者信息

Steiner Normann, Göbel Georg, Mauser Leonie, Mühlnikel Lena, Fischinger Marie, Künz Tina, Willenbacher Wolfgang, Hetzenauer Gabriele, Rudzki Jakob, Nussbaumer Walter, Mayer Wolfgang, Gunsilius Eberhard, Kircher Brigitte, Wolf Dominik, Nachbaur David

机构信息

Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.

Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schöpfstrasse 41/1, A-6020 Innsbruck, Austria.

出版信息

Cancers (Basel). 2023 Jan 18;15(3):608. doi: 10.3390/cancers15030608.

Abstract

In our single-center study, 357 myeloma and lymphoma patients between 2009 and 2019 were mobilized with granulocyte colony-stimulating factor (G-CSF 7.5 µg/kg bid for four days) plus a fixed dose of 24 mg Plerixafor when indicated (Plerixafor Group, = 187) or G-CSF alone (G-CSF Group, = 170). The target CD34 cell yields were ≥2.0 × 10 CD34+ cells/kg in lymphoma and ≥4.0 × 10 CD34+ cells/kg in myeloma patients to enable putative second transplants in the latter. There were no significant differences in engraftment kinetics or transfusion requirements between the Plerixafor Group and the control group in the myeloma cohort, with lymphoma patients not requiring Plerixafor showing significantly faster neutrophil recovery, a trend to faster platelet recovery, and a significantly lower need for platelet transfusions, probably due to the significantly lower number of CD34-positive cells re-transfused. While in myeloma patients the outcome (overall survival, progression-free survival) following autologous stem cell transplantation (ASCT) was similar between the Plerixafor Group and the control group, hard to mobilize lymphoma patients had significantly poorer progression-free survival (47% vs. 74% at 36 months after ASCT, = 0.003) with a trend also to poorer overall survival (71% vs. 84%). In conclusion, while there seem to be no differences in stemness capacity and long-term engraftment efficiency between the Plerixafor and the G-CSF Group in lymphoma as well as myeloma patients, poor mobilizing lymphoma patients per se constitute a high-risk population with a poorer outcome after ASCT. Whether disease characteristics and/or a more intense or stem cell-toxic pre-mobilization chemo-/radiotherapy burden in this cohort are responsible for this observation remains to be shown in future studies.

摘要

在我们的单中心研究中,2009年至2019年间的357例骨髓瘤和淋巴瘤患者接受动员,其中187例患者使用粒细胞集落刺激因子(G-CSF,7.5μg/kg,每日两次,共四天)加固定剂量24mg普乐沙福(必要时使用)(普乐沙福组),170例患者仅使用G-CSF(G-CSF组)。淋巴瘤患者的目标CD34细胞产量为≥2.0×10⁶ CD34⁺细胞/kg,骨髓瘤患者为≥4.0×10⁶ CD34⁺细胞/kg,以便后者能够进行二次移植。在骨髓瘤队列中,普乐沙福组与对照组之间的植入动力学或输血需求无显著差异,未使用普乐沙福的淋巴瘤患者中性粒细胞恢复明显更快,血小板恢复有加快趋势,血小板输血需求显著更低,这可能是由于再次输注的CD34阳性细胞数量显著更少。虽然在骨髓瘤患者中,普乐沙福组与对照组自体干细胞移植(ASCT)后的结局(总生存期、无进展生存期)相似,但动员困难的淋巴瘤患者无进展生存期明显更差(ASCT后36个月时分别为47%和74%,P = 0.003),总生存期也有较差趋势(分别为71%和84%)。总之,虽然在淋巴瘤和骨髓瘤患者中,普乐沙福组与G-CSF组之间的干性能力和长期植入效率似乎没有差异,但动员困难的淋巴瘤患者本身是一个高危人群,ASCT后的结局较差。该队列中疾病特征和/或动员前更强烈或对干细胞有毒性的化疗/放疗负担是否导致了这一观察结果,仍有待未来研究证实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81df/9913576/3cda3e56fda3/cancers-15-00608-g001.jpg

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