多发性骨髓瘤患者行 upfront 自体造血干细胞移植时的最优输注 CD34 细胞剂量。
Optimal infused CD34 cell dose in multiple myeloma patients undergoing upfront autologous hematopoietic stem cell transplantation.
机构信息
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Hematology, Dalhousie University, Halifax, NS, Canada.
出版信息
Blood Cancer J. 2024 Oct 31;14(1):189. doi: 10.1038/s41408-024-01165-w.
Autologous transplantation remains the standard of care for eligible multiple myeloma (MM) patients, yet optimal CD34 cell dose remains unclear. We conducted a retrospective study on MM patients undergoing upfront transplant between 2005 and 2021 and divided them into low (≤2.5 × 10 cells/kg) and high (>2.5 × 10 cells/kg) CD34 dose groups. We included 2479 patients, 95 in the low CD34 group and 2384 in the high CD34 group. Patients in the low CD34 group were older (63.2 vs 61.1 years, p = 0.013), more often had R-ISS III (19% vs 9%, p = 0.014), received plerixafor (60% vs 35%, p < 0.001) and transplanted after 2009 (88% vs 80%, p = 0.047). Time to neutrophil and platelet recovery was longer in the low CD34 group. Median PFS and OS were lower in the low CD34 group (31.6 vs. 43.6 months, p = 0.011 and 76.4 vs. 108.2 months, p < 0.001, respectively). Evaluation of incrementally higher CD34 dose did not show significant improvement in survival at thresholds >2.5 × 10 cells/kg. Multivariable analysis affirmed that CD34 >2.5 × 10 cells/kg was associated with better PFS (HR 0.71, p = 0.008) and OS (0.59, p < 0.001). After propensity score matching, a CD34 dose >2.5 × 10 cells/kg remained a predictor of better OS (0.42, p < 0.001). In conclusion, CD34 dose >2.5 × 10 cells/kg was associated with improved survival, without any additional benefit at incrementally higher doses.
自体移植仍然是适合的多发性骨髓瘤（MM）患者的标准治疗方法，但最佳 CD34 细胞剂量仍不清楚。我们对 2005 年至 2021 年间进行 upfront 移植的 MM 患者进行了回顾性研究，并将其分为低（≤2.5×10^6 细胞/kg）和高（>2.5×10^6 细胞/kg）CD34 剂量组。我们纳入了 2479 名患者，低 CD34 组 95 例，高 CD34 组 2384 例。低 CD34 组患者年龄更大（63.2 岁 vs 61.1 岁，p=0.013），更多为 R-ISS III 期（19% vs 9%，p=0.014），接受培非格司亭（60% vs 35%，p<0.001），并在 2009 年后移植（88% vs 80%，p=0.047）。低 CD34 组的中性粒细胞和血小板恢复时间更长。低 CD34 组的中位 PFS 和 OS 较低（31.6 个月 vs. 43.6 个月，p=0.011 和 76.4 个月 vs. 108.2 个月，p<0.001）。评估更高的 CD34 剂量增量在>2.5×10^6 细胞/kg 阈值时并未显示出显著改善生存。多变量分析证实，CD34>2.5×10^6 细胞/kg 与更好的 PFS（HR 0.71，p=0.008）和 OS（0.59，p<0.001）相关。在倾向评分匹配后，CD34 剂量>2.5×10^6 细胞/kg 仍然是 OS 更好的预测因素（0.42，p<0.001）。总之，CD34 剂量>2.5×10^6 细胞/kg 与生存改善相关，而在更高的剂量增量时没有任何额外的益处。
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