Department of Hematology, School of Medicine, The First Affiliated Hospital of Xiamen University and Institute of Hematology, Xiamen University, Xiamen, 361102, People's Republic of China.
Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, 361102, People's Republic of China.
Ann Hematol. 2024 Oct;103(10):3839-3853. doi: 10.1007/s00277-024-05683-2. Epub 2024 Mar 6.
The roles of Lenalidomide (Len) and Daratumumab (Dara) in multiple myeloma treatment are well-established, yet their influences on hematopoietic stem cell harvesting and reconstitution remain disputed.
We conducted a systematic database review to identify cohort studies or RCTs evaluating the effect of the use of Len or Dara on hematopoietic stem cell collection and peripheral blood count recovery in multiple myeloma patients. Effects on hematopoietic collection or reconstitution were estimated by comparing standardized mean differences (SMD) and mean differences (MD), or median differences.
Eighteen relevant studies were identified, summarizing mobilization results. For Len, data from 13 studies were summarized, including total CD34+ cell yield, collection failure rate, and time to neutrophil and platelet engraftment. Results indicated that Len exposure led to decreased stem cell collection [SMD=-0.23, 95% CI (-0.34, -0.12)]. However, collection failure (<2×106) could be mitigated by plerixafor [OR=2.14, 95% CI (0.96, 4.77)]. For Dara, two RCTs and three cohort studies were included, showing that Dara exposure resulted in a reduction in total stem cells even with optimized plerixafor mobilization [SMD=-0.75, 95% CI (-1.26, -0.23)], and delayed platelet engraftment recovery [MD=1.20, 95% CI (0.73, 1.66)].
Our meta-analysis offers a comprehensive view of Len and Dara's impacts on hematopoietic stem cell collection and reconstitution in multiple myeloma. Len usage could lead to reduced stem cell collection, counteracted by plerixafor mobilization. Dara usage could result in diminished stem cell collection and delayed platelet engraftment.
来那度胺（Len）和达雷妥尤单抗（Dara）在多发性骨髓瘤治疗中的作用已得到充分证实，但它们对造血干细胞采集和重建的影响仍存在争议。
我们进行了系统的数据库综述，以确定评估 Len 或 Dara 使用对多发性骨髓瘤患者造血干细胞采集和外周血计数恢复影响的队列研究或 RCT。通过比较标准化均数差（SMD）和均数差（MD）或中位数差来评估对造血采集或重建的影响。
确定了 18 项相关研究，总结了动员结果。对于 Len，总结了 13 项研究的数据，包括总 CD34+细胞产量、采集失败率以及中性粒细胞和血小板植入的时间。结果表明，Len 暴露导致干细胞采集减少[SMD=-0.23，95%CI（-0.34，-0.12）]。然而，用普乐沙福可以减轻采集失败（<2×106）[OR=2.14，95%CI（0.96，4.77）]。对于 Dara，纳入了两项 RCT 和三项队列研究，表明即使优化了普乐沙福动员，Dara 暴露也会导致总干细胞减少[SMD=-0.75，95%CI（-1.26，-0.23）]，并且血小板植入恢复延迟[MD=1.20，95%CI（0.73，1.66）]。
我们的荟萃分析全面评估了 Len 和 Dara 对多发性骨髓瘤患者造血干细胞采集和重建的影响。Len 的使用可能导致干细胞采集减少，通过普乐沙福动员来抵消。Dara 的使用可能导致干细胞采集减少和血小板植入延迟。
