Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Cancer Med. 2024 Jun;13(11):e7356. doi: 10.1002/cam4.7356.
Multiple myeloma (MM) is the leading indication of autologous hematopoietic stem cell transplantation. The aim of this study was to determine the incidence of mobilization failure and characterize the risk factors associated with poor mobilization (PM) of MM patients in novel therapies era.
We conducted a retrospective study of 211 MM patients who received their first peripheral blood stem cells (PBSC) mobilization at our single center. The following data were collected: age, gender, clinical stage, disease status, complete blood cell count, induction regimen, CD34 cell count in peripheral blood (PB), and PBSC collections.
In addition to conventional drugs, 22 (10.4%) patients received daratumumab containing induction, and 33 (15.6%) patients used plerixafor for poor mobilization (pre-apheresis PB CD34 cells <20/μL). Failure of collection occurred in 24 (11.4%) patients and was correlated with low white blood cell (WBC), ≥3 cycles of lenalidomide treatment before mobilization, steady-state mobilization and nouse of plerixafor are associated with mobilization failure. Daratumumab-based induction treatment ≥2 courses, albumin >41 g/L before mobilization, and steady-state mobilization were risk factors for PM in subgroups of patients treated with lenalidomide for <3 courses. In addition, Hepatitis B virus infection at baseline, thalassemia and measurable residual disease positivity were recognized as predictive factors for PM in subset of chemo-mobilization patients.
In addition to some well-recognized risk factors, baseline WBC count and daratumumab exposure ≥2 courses before mobilization were revealed as the predictive factors of mobilization failure, providing consultation for preemptive use of plerixafor.
多发性骨髓瘤（MM）是自体造血干细胞移植的主要适应证。本研究旨在确定新型疗法时代 MM 患者动员失败的发生率，并确定与动员不良（PM）相关的危险因素。
我们对在我院单中心接受首次外周血造血干细胞（PBSC）动员的 211 例 MM 患者进行了回顾性研究。收集以下数据：年龄、性别、临床分期、疾病状态、全血细胞计数、诱导方案、外周血（PB）中 CD34 细胞计数和 PBSC 采集情况。
除常规药物外，22 例（10.4%）患者接受达雷妥尤单抗联合诱导方案，33 例（15.6%）患者使用普乐沙福治疗动员不良（预处理 PB CD34 细胞<20/μL）。24 例（11.4%）患者采集失败，与白细胞（WBC）低、动员前 lenalidomide 治疗≥3 个周期、稳态动员和使用普乐沙福有关。达雷妥尤单抗为基础的诱导治疗≥2 个疗程、动员前白蛋白>41g/L 和稳态动员是 lenalidomide 治疗<3 个疗程的患者亚组发生 PM 的危险因素。此外，基线乙型肝炎病毒感染、地中海贫血和可测量残留疾病阳性被认为是化疗动员患者亚组发生 PM 的预测因素。
除了一些公认的危险因素外，动员前 WBC 计数和达雷妥尤单抗暴露≥2 个疗程被揭示为动员失败的预测因素，为提前使用普乐沙福提供了参考。
