Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ann Med. 2023;55(2):2289603. doi: 10.1080/07853890.2023.2289603. Epub 2023 Dec 17.
This study aimed to clarify the effectiveness and safety of two different infusion durations of cyclophosphamide (CTX) plus granulocyte colony-stimulating factor (G-CSF) for peripheral blood stem cell mobilization in patients with newly diagnosed multiple myeloma (NDMM).
One hundred and fifty-six consecutive NDMM patients receiving CTX plus G-CSF mobilization and autologous stem cell transplantation during the period of September 2008 to May 2020 were selected for retrospective analysis. According to differences in prolonged infusion time of CTX, they were divided into a 24-h group (24-h continuous infusion) and a control group (4-6 h of infusion). Mobilization and safety of infusion were analyzed. Flow cytometry was used to detect the peripheral blood CD34+ cell count. Multivariate analysis was performed to determine the factors influencing the number of CD34+ cells.
The mean CD34+ cell counts collected in 24-h and control groups were 6.78 (interquartile range [IQR] 3.59-11.69) and 4.48 (IQR 2.39-6.30) ×10/kg, respectively ( < 0.001). Meanwhile, the target number of CD34+ cells/kg (defined as ≥4 × 10/kg) was collected from 51 (75%) of cases in 24-h group vs. 45 (51%) in the control group ( = 0.002). Multivariate analysis identified the independence of CTX infusion time as a factor influencing the target number of CD34+ cells/kg [odds ratio OR, 4.045; 95% CI: 1.630-10.038, = 0.003]. The post-transplantation time to neutrophil engraftment was 10 (IQR 9-11) in 24-h group and 11 (IQR 10-12) in control group ( < 0.001). Finally, no statistical differences were identified between groups in terms of hematologic and non-hematologic toxicities.
For patients with NDMM, 24-h continuous infusion of CTX plus G-CSF contributes to improved mobilization efficiency and equivalent toxicity as a stem cell mobilization regimen.
本研究旨在阐明不同环磷酰胺（CTX）输注时间持续时间对新诊断多发性骨髓瘤（NDMM）患者外周血造血干细胞动员的有效性和安全性。
回顾性分析 2008 年 9 月至 2020 年 5 月期间接受 CTX 联合 G-CSF 动员和自体干细胞移植的 156 例连续 NDMM 患者。根据 CTX 延长输注时间的差异，将患者分为 24 小时组（24 小时连续输注）和对照组（4-6 小时输注）。分析动员和输注的安全性。流式细胞术检测外周血 CD34+细胞计数。采用多变量分析确定影响 CD34+细胞数量的因素。
24 小时组和对照组采集的平均 CD34+细胞计数分别为 6.78（四分位距 [IQR] 3.59-11.69）和 4.48（IQR 2.39-6.30）×106/kg（ < 0.001）。同时，24 小时组 51 例（75%）达到目标 CD34+细胞/kg（定义为≥4×106/kg），对照组 45 例（51%）达到目标值（ = 0.002）。多变量分析确定 CTX 输注时间是影响目标 CD34+细胞/kg 的独立因素[比值比 OR，4.045；95%置信区间：1.630-10.038， = 0.003]。24 小时组中性粒细胞植入的移植后时间为 10（IQR 9-11），对照组为 11（IQR 10-12）（ < 0.001）。最后，两组在血液学和非血液学毒性方面无统计学差异。
对于 NDMM 患者，CTX 联合 G-CSF 24 小时连续输注可提高动员效率，且作为干细胞动员方案毒性相当。
