Chandler Thea, Parrish Christopher, Karakantza Marina, Carmichael Jonathan, Pawson David, Cook Gordon, Seymour Frances
St James's Institute of Oncology Leeds Teaching Hospitals NHS Trust Leeds UK.
NHS Blood and Transplant Barnsley UK.
EJHaem. 2023 May 8;4(3):625-630. doi: 10.1002/jha2.702. eCollection 2023 Aug.
Collection of peripheral blood stem cells (PBSCs) for autologous stem cell transplant (ASCT) requires mobilization from the bone marrow. There is variation in mobilization choice; during the COVID-19 pandemic BSBMT&CT guidelines recommended using granulocyte-colony stimulating factor (G-CSF) alone to minimize the use of chemotherapy. We report on the impact of mobilization regimen on stem cell collection, and whether IMiD-containing induction therapy impacts on mobilization and consequently transplant engraftment times for 83 patients undergoing ASCT at Leeds Teaching Hospitals. Cyclophosphamide plus G-CSF (cyclo-G) mobilization yielded more CD34 cells (8.94 vs. 4.88 ×10/kg, = < 0.0001) over fewer days (1.6 vs. 2.4 days, = 0.007), and required fewer doses of salvage Plerixafor than G-CSF only (13.6% vs. 35%, = 0.0407). IMiD-containing induction impaired all of these factors. CD34 doses > 8×10/kg were more frequent with Cyclo-G (62% vs. 11%, = 0.0001), including for those receiving IMiD 1st line induction (50% vs. 13.3%, p = 0.0381). Note that 92.6% of those receiving IMiD-free inductions were mobilized with Cyclo-G. The novel agents used in modern induction regimens (e.g Daratumumab) have been shown to impair yields, increasing the importance of optimizing mobilization regimens in the first instance. Furthermore, as cellular therapies become established in the management of multiple myeloma emerging data highlights the potential benefits of stem cell top up in the management of the haematological toxicities of these therapies. Our findings support re-adoption of Cyclo-G as the gold standard for mobilization to optimize PBSC harvesting and ensure sufficient cells for subsequent ASCTs.
用于自体干细胞移植（ASCT）的外周血干细胞（PBSCs）采集需要从骨髓中动员。动员方案存在差异；在新冠疫情期间，英国血液与骨髓移植及细胞治疗学会（BSBMT&CT）指南建议单独使用粒细胞集落刺激因子（G-CSF）以尽量减少化疗的使用。我们报告了动员方案对干细胞采集的影响，以及含免疫调节药物（IMiD）的诱导治疗是否会影响动员，进而影响利兹教学医院83例接受ASCT患者的移植植入时间。环磷酰胺加G-CSF（环磷酰胺-G-CSF，cyclo-G）动员方案在更少天数内产生了更多的CD34细胞（8.94对4.88×10/kg，P = <0.0001）（1.6天对2.4天，P = 0.007），并且与仅使用G-CSF相比，所需的挽救性普乐沙福剂量更少（13.6%对35%，P = 0.0407）。含IMiD的诱导治疗损害了所有这些因素。环磷酰胺-G-CSF方案中CD34剂量>8×10/kg的情况更常见（62%对11%，P = 0.0001），包括那些接受IMiD一线诱导治疗的患者（50%对13.3%，P = 0.0381）。请注意，92.6%接受不含IMiD诱导治疗的患者采用环磷酰胺-G-CSF方案进行动员。现代诱导方案中使用的新型药物（如达雷妥尤单抗）已被证明会降低产量，这凸显了首先优化动员方案的重要性。此外，随着细胞疗法在多发性骨髓瘤管理中的确立，新出现的数据凸显了干细胞补充在这些疗法血液学毒性管理中的潜在益处。我们的研究结果支持重新采用环磷酰胺-G-CSF作为动员的金标准，以优化PBSC采集并确保为后续ASCT提供足够的细胞。
