Wolf Julia S, Seymour Frances, Parrish Christopher, Chandler Thea, Holt Matthew, Griffin James, Karakantza Marina
Bristol Haematology and Oncology Centre, Bristol, UK.
St James University Hospital, LTHT, Leeds, UK.
J Clin Apher. 2025 Apr;40(2):e70012. doi: 10.1002/jca.70012.
Autologous stem cell transplant (ASCT) requires the collection of hematopoietic progenitor cells, commonly by apheresis (HPC-A). These CD34+ cells can be mobilized using Granulocyte Colony Stimulating Factor (G-CSF) only or chemomobilization plus G-CSF. Both methods may additionally include Plerixafor. The emergence of COVID-19 led to recommendations for preferential G-CSF only mobilization. To assess the impact of this recommendation on HPC-A harvesting, we analyzed data from the NHS Blood and Transplant Stem Cell Collection Registry for 1342 patients undergoing 2431 HPC-A procedures between 01/01/2019 and 31/12/2021. We compared G-CSF only, cyclophosphamide plus G-CSF (Cyclo-G) and G-CSF plus alternative chemotherapy (Chemo+G) mobilization. The outcomes collected were pre-apheresis CD34+ count, CD34+ yield per procedure, total CD34+ yield, number of apheresis procedures required to achieve the CD34+ target, mobilization failure, and Plerixafor use (+P). In multiple myeloma (MM), Cyclo-G (+/-P) mobilization produced significantly higher CD34+ yields than G-CSF only (7.44 vs. 4.75 × 10/kg; p < 0.0001). In Hodgkin lymphoma (HL) there was no statistically significant difference between regimes (CD34+ yield 4.53 × 10/kg with G-CSF only (+/-P), 5.52 × 10/kg with Cyclo-G (+/-P), 4.32 × 10/kg with Chemo+G (+/-P)). In Non-Hodgkin lymphoma (NHL), Chemo+G (+/-P) was the most successful regime (5.98 × 10/kg vs. 3.7 × 10/kg with G-CSF only (+/-P) vs. 3.69 × 10/kg with Cyclo-G (+/-P); p < 0.00001). On demand Plerixafor use resulted in > 95% successful mobilization in MM and NHL. CD34+ yields are higher using Cyclo-G and Chemo+G in NHL. In MM, G-CSF only resulted in yields sufficient for at least one transplant. In HL, our data show no evidence to support the use of Cyclo-G over G-CSF only.
自体干细胞移植（ASCT）需要采集造血祖细胞，通常通过单采术（HPC-A）进行。这些CD34+细胞可以仅使用粒细胞集落刺激因子（G-CSF）动员，或者采用化疗动员加G-CSF的方式。两种方法都可能额外使用普乐沙福。COVID-19的出现导致了优先仅使用G-CSF动员的建议。为了评估这一建议对HPC-A采集的影响，我们分析了英国国民医疗服务体系血液与移植干细胞采集登记处的数据，这些数据来自2019年1月1日至2021年12月31日期间接受2431次HPC-A程序的1342名患者。我们比较了仅使用G-CSF、环磷酰胺加G-CSF（Cyclo-G）以及G-CSF加其他化疗药物（Chemo+G）的动员方式。收集的结果包括单采术前CD34+计数、每次程序的CD34+产量、总CD34+产量、达到CD34+目标所需的单采程序次数、动员失败情况以及普乐沙福的使用情况（+P）。在多发性骨髓瘤（MM）中，Cyclo-G（±P）动员产生的CD34+产量显著高于仅使用G-CSF（7.44对4.75×10/kg；p＜0.0001）。在霍奇金淋巴瘤（HL）中各方案之间无统计学显著差异（仅使用G-CSF（±P）时CD34+产量为4.53×10/kg，Cyclo-G（±P）时为5.52×10/kg，Chemo+G（±P）时为4.32×10/kg）。在非霍奇金淋巴瘤（NHL）中Chemo+G（±P）是最成功的方案（5.98×10/kg，而仅使用G-CSF（±P）时为3.7×10/kg，Cyclo-G（±P）时为3.69×10/kg；p＜0.00001）。按需使用普乐沙福在MM和NHL中导致＞95%的成功动员。在NHL中使用Cyclo-G和Chemo+G时CD34+产量更高。在MM中，仅使用G-CSF产生的产量足以进行至少一次移植。在HL中，我们的数据表明没有证据支持使用Cyclo-G而非仅使用G-CSF。
