Kriegsmann Katharina, Bittrich Max, Sauer Sandra, Tietze-Stolley Carola, Movassaghi Kamran, Grube Matthias, Vucinic Vladan, Wehler Daniela, Burchert Andreas, Schmidt-Hieber Martin, Rank Andreas, Dürk Heinz A, Metzner Bernd, Kimmich Christoph, Hentrich Marcus, Kunz Christian, Hartmann Frank, Khandanpour Cyrus, de Wit Maike, Holtick Udo, Kiehl Michael, Stoltefuß Andrea, Kiani Alexander, Naumann Ralph, Scholz Christian W, Tischler Hans-Joachim, Görner Martin, Brand Franziska, Ehmer Martin, Kröger Nicolaus
Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
Laborarztpraxis, Laborarztpraxis Rhein-Main MVZ GbR, Limbach Gruppe SE, Frankfurt, Germany.
Transfus Med Hemother. 2023 Sep 21;50(5):403-416. doi: 10.1159/000531936. eCollection 2023 Oct.
Successful mobilization and collection of peripheral hematopoietic stem cells (HSCs) are necessary for lymphoma patients eligible for myeloablative chemotherapy with subsequent autologous stem cell transplantation (ASCT). Albeit G-CSF alone or combined with chemotherapy is well-established methods for HSC mobilization, up to 40% of the patients fail to mobilize (poor mobilizer, PM). Plerixafor (PLX) is commonly used in PM patients resulting in increased migration of HSCs into peripheral blood and thus improves the collection outcome.
The prospective, multicenter, open-label, non-interventional OPTIMOB study assessed mobilization and collection parameter of patients with lymphoma or multiple myeloma to get deep insights in the treatment of those patients in clinical routine focusing on PM patients. PM was defined as follows: (1) no achievement of ≥20 CD34 progenitor cells/µL before first apheresis, (2) PLX administration at any time point during the observational period, (3) reduction of the initially planned CD34 progenitor cell yield as necessity due to failed mobilization or HSC collection, and (4) no performance of apheresis due to low CD34 progenitor level. Primary objective of the study was to assess mobilization success by the proportion of PM patients achieving >2 × 10 CD34 progenitor cells/kg body weight on the first day of apheresis. Here, the data of the lymphoma cohort are presented.
Out of 238 patients with lymphoma documented in the study, 32% were classified as PM. 87% of them received PLX. Demographic data revealed no obvious differences between PM and good mobilizing (GM) patients. All patients were treated highly individualized prior to mobilization. Majority of all PM patients were able to undergo apheresis (95%) and reached their individual requested CD34 progenitor cell target (72%). 57% of the PM patients achieved >2.0 × 10 CD34 progenitor cells/kg body weight on day 1 of apheresis and nearby 70% of them underwent ASCT. Median time to engraftment was similar in PM and GM patients of the lymphoma cohort.
Majority of PM patients with lymphoma were successfully mobilized and underwent ASCT. Most of them received PLX during the study.
对于有资格接受清髓性化疗并随后进行自体干细胞移植（ASCT）的淋巴瘤患者，成功动员和采集外周造血干细胞（HSC）是必要的。尽管单独使用粒细胞集落刺激因子（G-CSF）或与化疗联合是公认的HSC动员方法，但仍有高达40%的患者动员失败（动员不佳者，PM）。普乐沙福（PLX）常用于PM患者，可使HSC向外周血的迁移增加，从而改善采集效果。
前瞻性、多中心、开放标签、非干预性的OPTIMOB研究评估了淋巴瘤或多发性骨髓瘤患者的动员和采集参数，以深入了解临床常规中这些患者的治疗情况，重点关注PM患者。PM的定义如下：（1）首次单采前未达到≥20个CD34祖细胞/微升；（2）在观察期内的任何时间点使用PLX；（3）由于动员失败或HSC采集失败，按需要减少最初计划的CD34祖细胞产量；（4）由于CD34祖细胞水平低而未进行单采。该研究的主要目的是通过单采第一天PM患者中达到>2×10个CD34祖细胞/千克体重的比例来评估动员成功率。在此，展示淋巴瘤队列的数据。
在该研究记录的238例淋巴瘤患者中，32%被归类为PM。其中87%接受了PLX。人口统计学数据显示PM患者和动员良好（GM）患者之间无明显差异。所有患者在动员前均接受了高度个体化治疗。所有PM患者中的大多数能够进行单采（95%）并达到其个人所需的CD34祖细胞目标（72%）。57%的PM患者在单采第一天达到>2.0×10个CD34祖细胞/千克体重，其中近70%接受了ASCT。淋巴瘤队列中PM患者和GM患者的中位植入时间相似。
大多数淋巴瘤PM患者成功动员并接受了ASCT。他们中的大多数在研究期间接受了PLX。
