Kwon Soyean, Park Hye Yeon, Byun Ja Min, Shin Dong-Yeop, Koh Youngil, Hong Junshik, Kim Inho, Yoon Sung-Soo
Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Ann Hematol. 2025 Apr;104(4):2297-2304. doi: 10.1007/s00277-025-06372-4. Epub 2025 Apr 25.
Autologous stem cell transplantation (ASCT) is integral to treating newly diagnosed multiple myeloma (MM). While novel therapies improve response rates, they also hinder stem cell mobilization. This study evaluates the impacts of induction regimens on mobilization, collection, and ASCT outcomes. We analyzed 228 patients divided into three groups: bortezomib-thalidomide-dexamethasone (VTD, N = 117); bortezomib-lenalidomide-dexamethasone (VRD, N = 57); and daratumumab-VTD (DVTD, N = 54). Baseline characteristics showed no significant differences among the groups. Chemo-mobilization was most common in VTD (20.5%) compared to VRD (12.3%) and DVTD (5.6%). Total CD34 + cell yield (x10⁶/kg) was highest in VTD (7.1 ± 3.5) compared to VRD (5.8 ± 3.2) and DVTD (5.4 ± 2.4) [p = 0.0001]. Second mobilization was required most frequently in VRD (40.4%) compared to DVTD (24.1%) and VTD (16.2%) [p = 0.0010]. Plerixafor use was highest in VRD (40.4%) compared to DVTD (24.1%) and VTD (12.0%) [p = 0.0001]. Mobilization duration was longest in VRD (4.0 ± 1.9 days) and shortest in VTD (3.2 ± 1.7 days) [p = 0.0038]. Infused CD34 cells and platelet engraftment times were comparable among groups. Neutrophil engraftment was delayed in VRD (12.1 ± 0.9 days) compared to DVTD (11.8 ± 1.2) and VTD (11.6 ± 0.7) [p = 0.0014]. Prompt stem cell collection is essential in lenalidomide regimens to minimize mobilization challenges. While DVTD demonstrated comparable mobilization efficiency, it produced fewer CD34 cells than VTD, indicating potential challenges.
自体干细胞移植（ASCT）是治疗新诊断的多发性骨髓瘤（MM）不可或缺的一部分。虽然新型疗法提高了缓解率，但也阻碍了干细胞的动员。本研究评估了诱导方案对动员、采集及ASCT结果的影响。我们分析了228例患者，分为三组：硼替佐米-沙利度胺-地塞米松（VTD，n = 117）；硼替佐米-来那度胺-地塞米松（VRD，n = 57）；以及达雷妥尤单抗-VTD（DVTD，n = 54）。基线特征显示各组间无显著差异。与VRD（12.3%）和DVTD（5.6%）相比，化疗动员在VTD中最为常见（20.5%）。与VRD（5.8±3.2）和DVTD（5.4±2.4）相比，VTD的总CD34 +细胞产量（×10⁶/kg）最高（7.1±3.5）[p = 0.0001]。与DVTD（24.1%）和VTD（16.2%）相比，VRD最常需要进行第二次动员（40.4%）[p = 0.0010]。与DVTD（24.1%）和VTD（12.0%）相比，VRD使用普乐沙福的比例最高（40.4%）[p = 0.0001]。VRD的动员持续时间最长（4.0±1.9天），VTD最短（3.2±1.7天）[p = 0.0038]。各组间输注的CD34细胞和血小板植入时间相当。与DVTD（11.8±1.2）和VTD（11.6±0.7）相比，VRD的中性粒细胞植入延迟（12.1±0.9天）[p = 0.0014]。在来那度胺方案中，迅速进行干细胞采集对于将动员挑战降至最低至关重要。虽然DVTD显示出相当的动员效率，但其产生的CD34细胞比VTD少，表明存在潜在挑战。
