Departement of Blood Transfusion Medicine, S. Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Division of Hematology, S. Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy.
Departement of Blood Transfusion Medicine, S. Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
Transfus Apher Sci. 2023 Dec;62(6):103845. doi: 10.1016/j.transci.2023.103845. Epub 2023 Nov 3.
Poor CD34 + cells mobilization in allogeneic donors could affect transplant outcome. In a subgroup of patient mobilization with granulocyte colony-stimulating factor (G-CSF) alone is unsatisfactory, and Plerixafor could be used to enhance CD34 + cells release from bone marrow niche.
We conducted a retrospective single-center, cohort study on healthy allogeneic donors both related and unrelated, treated by Udine Transfusion Center over the last 10 years (2012-2022). In the 195 allogeneic donors treated we analyzed age, sex, body weight, BMI, comorbidities, G-CSF dosage and even baseline white blood cell count as possible predictor of insufficient CD34 + cells mobilization on day 5. In the subgroup of related donors we evaluated even baseline CD34 + cells (measured before mobilization start). Processed donor blood volume, collection efficiency and apheresis product were examined. Additionally a comparative analysis was conducted between G-CSF alone treated donors and poor mobilizing ones, in which Plerixafor was administered at a dose of 0.24 mg/kg as a pre-emptive or rescue agent.
In 9 donors, due to poor mobilization (defined as CD34 + < 20/µL or estimated yield < 1 ×10 kg/recipient body weight), the use of plerixafor was necessary. PLX at a dose of 0.24 mg/kg was administered 5 h before collection, inducing an average increase of 5.1 (1.7-12.6) in CD34 + circulating cells. In this subgroup of patients, BMI and weight were significantly lower (p = 0.03). Interestingly, baseline CD34 + cells (measured before the onset of mobilization) also seems to predict poor mobilization (p = 0.003). In donors additionally treated with Plerixafor compared to those who received G-CSF alone, collection efficiency was higher (p = 0.02) and CD34 + cells collected were comparable (p = 0.2). Side effects related to the administration of plerixafor, if they occurred, were well tolerated.
Plerixafor is a safe and effective drug in the rescue and prevention of poor mobilization. New prospective studies on allogeneic donors should be performed to increase the treatable population to avoid inadequate collection and mobilization. New laboratory predictors such as baseline CD34 + cells should be investigated in larger cohorts and then used as early screening.
异基因供者中 CD34+细胞动员不良可能会影响移植结果。在单独使用粒细胞集落刺激因子（G-CSF）进行患者动员的亚组中，效果并不理想，此时可以使用普乐沙福来增强 CD34+细胞从骨髓龛中的释放。
我们对乌迪内输血中心过去 10 年（2012-2022 年）治疗的所有相关和无关的健康异基因供者进行了回顾性单中心队列研究。在 195 名接受治疗的异基因供者中，我们分析了年龄、性别、体重、BMI、合并症、G-CSF 剂量，甚至基线白细胞计数等，以作为第 5 天 CD34+细胞动员不足的可能预测因素。在相关供者亚组中，我们甚至评估了基线 CD34+细胞（在动员开始前测量）。检查了处理后的供者血液量、采集效率和单采产物。此外，还对单独使用 G-CSF 治疗的供者与动员不良的供者进行了对比分析，对后者以 0.24mg/kg 的剂量预先或补救性地使用普乐沙福。
由于动员不良（定义为 CD34+<20/µL 或估计产量<1×10kg/受者体重），9 名供者需要使用普乐沙福。PLX 在采集前 5 小时以 0.24mg/kg 的剂量给药，导致循环 CD34+细胞平均增加 5.1（1.7-12.6）。在这些患者亚组中，BMI 和体重明显较低（p=0.03）。有趣的是，基线 CD34+细胞（在动员开始前测量）似乎也可以预测动员不良（p=0.003）。与单独接受 G-CSF 治疗的供者相比，额外接受普乐沙福治疗的供者的采集效率更高（p=0.02），且采集的 CD34+细胞相当（p=0.2）。如果发生，与普乐沙福给药相关的副作用均能耐受。
普乐沙福是一种安全有效的药物，可用于挽救和预防动员不良。应进行新的前瞻性研究，以增加可治疗的人群，避免采集和动员不足。应在更大的队列中研究新的实验室预测指标，如基线 CD34+细胞，并将其作为早期筛查手段。
