Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China.
Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China.
Cytotherapy. 2023 Aug;25(8):885-890. doi: 10.1016/j.jcyt.2023.04.014. Epub 2023 May 20.
An optimal strategy for mobilizing hematopoietic stem cells in poorly mobilizing patients with multiple myeloma (MM) and lymphoma has not yet been determined.
We retrospectively analyzed the efficacy and safety of etoposide combined with cytarabine (etoposide 75 mg/m, daily d1∼2; Ara-C 300 mg/m, every 12 h d1∼2), plus pegfilgrastim (6 mg d6) in 32 patients with MM or lymphoma, among whom 53.1% were defined as "proven poor mobilizers."
This approach resulted in adequate mobilization (≥2.0 × 10 CD34 cells/kg) in 93.8% of patients and optimal mobilization (≥5.0 × 10 CD34 cells/kg) in 71.9% of patients. A total of 100% of patients with MM reached at least 5 × 10 CD34 cells/kg collected, the amount required for double autologous stem cell transplant. In total, 88.2% of patients with lymphoma reached at least 2 × 10 CD34 cells/kg collected, the amount required for a single autologous stem cell transplant. This was achieved with a single leukapheresis in 78.1% of cases. A median peak number of 42.0/μL circulating CD34 cells and a median number of blood CD34 cells counts in 6.7 × 10/L were collected among 30 successful mobilizers. Approximately 6.3% of patients required plerixafor rescue, which was successful. Nine (28.1%) of the 32 patients suffered grade 2∼3 infections, and 50% required platelet transfusions.
We conclude that chemo-mobilization with etoposide, Ara-C and pegfilgrastim in poorly mobilizing patients with MM or lymphoma is very effective and has acceptable toxicity.
尚未确定多发性骨髓瘤（MM）和淋巴瘤患者造血干细胞动员效果不佳的最佳策略。
我们回顾性分析了表柔比星联合阿糖胞苷（表柔比星 75mg/m2，每天 d1∼2；阿糖胞苷 300mg/m2，每 12 小时 d1∼2）联合聚乙二醇化重组人粒细胞集落刺激因子（pegfilgrastim，6mg d6）在 32 例 MM 或淋巴瘤患者中的疗效和安全性，其中 53.1%被定义为“确认为动员不佳者”。
该方法使 93.8%的患者实现了充分动员（≥2.0×106 CD34 细胞/kg），71.9%的患者实现了最佳动员（≥5.0×106 CD34 细胞/kg）。100%的 MM 患者均至少采集到 5×106 CD34 细胞/kg，达到双自体干细胞移植的要求。88.2%的淋巴瘤患者至少采集到 2×106 CD34 细胞/kg，达到单自体干细胞移植的要求。78.1%的患者仅通过一次白细胞分离术即可达到上述目标。30 例成功动员者中，循环 CD34 细胞的中位峰值为 42.0/μL，血液中 CD34 细胞计数的中位值为 6.7×109/L。约 6.3%的患者需要普乐沙福挽救性治疗，且治疗有效。32 例患者中有 9 例（28.1%）发生 2∼3 级感染，50%的患者需要血小板输注。
我们认为，表柔比星、阿糖胞苷和 pegfilgrastim 联合化疗动员 MM 或淋巴瘤患者造血干细胞效果非常显著，且毒性可接受。
