Jantunen Esa, Partanen Anu, Turunen Antti, Varmavuo Ville, Silvennoinen Raija
Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland.
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Transfus Med Hemother. 2023 Aug 24;50(5):438-447. doi: 10.1159/000531940. eCollection 2023 Oct.
Multiple myeloma is currently the leading indication for autologous hematopoietic cell transplantation (AHCT). A prerequisite for AHCT is mobilization and collection of adequate blood graft to support high-dose therapy. Current mobilization strategies include granulocyte colony-stimulating factor (G-CSF) alone or in combination with chemotherapy most commonly cyclophosphamide (CY). More recently, plerixafor has become into agenda especially in patients who mobilize poorly. In the selection of a mobilization method, several factors should be considered.
Preplanned collection target is important as G-CSF plus plerixafor is more effective in the mobilization of CD34 cells than G-CSF alone. On the other hand, CY plus G-CSF is superior to G-CSF only mobilization. Previous therapy and age of the patients are important considerations as G-CSF alone may not be effective enough in patients with risk factors for poor mobilization. These factors include extensive lenalidomide exposure, irradiation to bone marrow-bearing sites, higher age, or a previous mobilization failure. Also, local preferences and experiences as well as the number of apheresis needed are important issues as well as cost-effectiveness considerations. Mobilization method used may have implication for cellular composition of collected grafts, which might have an impact on posttransplant events such as hematologic and immune recovery in addition to also potential long-term outcomes.
Currently, G-CSF alone and preemptive plerixafor if needed might be considered as a standard mobilization strategy in MM patients intended for AHCT.
多发性骨髓瘤目前是自体造血细胞移植（AHCT）的主要适应证。AHCT的一个前提条件是动员并采集足够的血液移植物以支持大剂量治疗。目前的动员策略包括单独使用粒细胞集落刺激因子（G-CSF）或与化疗联合使用，最常用的是环磷酰胺（CY）。最近，普乐沙福已被列入议程，特别是对于动员效果不佳的患者。在选择动员方法时，应考虑几个因素。
预先设定的采集目标很重要，因为G-CSF加普乐沙福在动员CD34细胞方面比单独使用G-CSF更有效。另一方面，CY加G-CSF优于仅用G-CSF进行动员。患者的既往治疗和年龄是重要的考虑因素，因为对于有动员不佳风险因素的患者，单独使用G-CSF可能不够有效。这些因素包括来那度胺广泛暴露、对含骨髓部位的照射、高龄或既往动员失败。此外，当地的偏好和经验以及所需的单采次数也是重要问题，还有成本效益的考量。所使用的动员方法可能会对采集的移植物的细胞组成产生影响，这除了可能影响长期结局外，还可能对移植后事件如血液学和免疫恢复产生影响。
目前，对于打算进行AHCT的MM患者，可将单独使用G-CSF以及必要时预先使用普乐沙福视为标准的动员策略。
