Department of Hematology, Shinko Hospital, Kobe, Japan; Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan.
Cytotherapy. 2023 Jul;25(7):773-781. doi: 10.1016/j.jcyt.2023.02.006. Epub 2023 Mar 12.
Before autologous stem cell transplantation (ASCT), hematopoietic stem cells must be stimulated to move from the bone marrow to the peripheral blood for harvesting. Plerixafor, a C-X-C chemokine receptor type 4 antagonist, is used to increase stem cell harvests. However, the effects of plerixafor on post-ASCT outcomes remain unclear.
In a dual-center retrospective cohort study of 43 Japanese patients who received ASCT, the authors compared transplantation outcomes in patients who underwent stem cell mobilization with granulocyte colony-stimulating factor with (n = 25) or without (n = 18) plerixafor.
The number of days to neutrophil and platelet engraftment was significantly shorter with plerixafor than without plerixafor, as assessed by univariate (neutrophil, P = 0.004, platelet, P = 0.002), subgroup, propensity score matching and inverse probability weighting analyses. Although the cumulative incidence of fever was comparable with or without plerixafor (P = 0.31), that of sepsis was significantly lower with plerixafor than without (P < 0.01). Thus, the present data indicate that plerixafor leads to earlier neutrophil and platelet engraftment and a reduction of infectious risk.
The authors conclude that plerixafor may be safe to use and that it reduces the risk of infection in patients with a low CD34+ cell count the day before apheresis.
在自体干细胞移植（ASCT）之前，造血干细胞必须被刺激从骨髓迁移到外周血中以进行采集。plerixafor 是一种 C-X-C 趋化因子受体 4 拮抗剂，用于增加干细胞采集量。然而，plerixafor 对 ASCT 后结局的影响尚不清楚。
在一项针对 43 名接受 ASCT 的日本患者的双中心回顾性队列研究中，作者比较了接受粒细胞集落刺激因子进行干细胞动员的患者（n=25）与未接受 plerixafor 治疗的患者（n=18）的移植结局。
在单变量分析（中性粒细胞，P=0.004，血小板，P=0.002）、亚组、倾向评分匹配和逆概率加权分析中，使用 plerixafor 的患者中性粒细胞和血小板植入的天数明显短于未使用 plerixafor 的患者。尽管使用或不使用 plerixafor 的发热累积发生率相当（P=0.31），但使用 plerixafor 的患者感染性败血症的发生率明显低于未使用 plerixafor 的患者（P<0.01）。因此，本研究数据表明，plerixafor 可实现更早的中性粒细胞和血小板植入，并降低感染风险。
作者得出结论，plerixafor 可能是安全的，并且在采集前一天 CD34+细胞计数较低的患者中降低了感染风险。
