Steady-state mobilization with on-demand plerixafor after CD38 antibody-based induction in multiple myeloma patients.

IF 2 3区医学 Q2 HEMATOLOGY

Transfusion Pub Date : 2026-04-01 Epub Date: 2026-03-20 DOI:10.1111/trf.70165

Maximilian Alexander Röhnert, Anna Seifert, Karolin Trautmann-Grill, Christoph Röllig, Kristin Zimmer, Katharina Egger-Heidrich, Marius Bill, Lisa Heberling, Freya Schulze, Matthias Blechschmidt, Malte von Bonin, Martin Bornhäuser, Kristina Hölig, Raphael Teipel

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引用次数: 0

Abstract

Background: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care for fit patients with newly diagnosed multiple myeloma (MM). The increasing use of CD38 antibody-based quadruplet induction regimens such as daratumumab-VTd (Dara-VTd) has raised concerns regarding impaired stem cell mobilization.

Study design and methods: We conducted a retrospective single-center analysis comparing steady-state stem cell mobilization after Dara-VTd versus bortezomib-cyclophosphamide-dexamethasone (VCd) induction. Mobilization kinetics, plerixafor use, and CD34⁺ collection outcomes were evaluated. CD34⁺ counts prior to first apheresis were adjusted for plerixafor use (adjCD34⁺). Multivariate logistic regression was performed to identify predictors of mobilization success.

Results: Among 153 patients, 85 received Dara-VTd and 68 received VCd. Despite significantly deeper responses after Dara-VTd (≥VGPR 81% vs. 42%; p < .01), these patients showed lower adjCD34⁺ counts prior to first apheresis (16 vs. 50/μL; p < .01) and required plerixafor more frequently (64% vs. 15%; p < .01). Nevertheless, cumulative CD34⁺ yields were comparable between Dara-VTd and VCd (6.4 vs. 6.0 × 10⁶ CD34⁺ cells/kg; p = .15), and target yields were achieved in the majority of patients proceeding to apheresis (90% vs. 94%). Dara-VTd induction, prior radiation, and high tumor burden were identified as independent negative predictors of mobilization success.

Discussion: Although Dara-VTd induction is associated with impaired mobilization kinetics, successful steady-state mobilization remains feasible. On-demand plerixafor use overcomes mobilization deficits, supporting this approach in patients receiving CD38-based quadruplet induction therapy. Furthermore, follow-up analysis of stem cell graft utilization demonstrates a high proportion of collected but unused stem cell grafts in both cohorts.

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在基于CD38抗体的多发性骨髓瘤患者诱导后，按需plerixafor的稳态动员。

背景：大剂量化疗后自体干细胞移植（ASCT）仍然是新诊断的多发性骨髓瘤（MM）患者的标准治疗方法。越来越多地使用基于CD38抗体的四联体诱导方案，如daratumumab-VTd (Dara-VTd)，引起了对受损干细胞动员的担忧。研究设计和方法：我们进行了一项回顾性单中心分析，比较Dara-VTd和硼替佐米-环磷酰胺-地塞米松（VCd）诱导后的稳态干细胞动员。评估动员动力学、多立沙的使用和CD34+收集结果。首次采珠前CD34+计数调整为plerixafor使用（adjCD34+）。采用多元逻辑回归来确定动员成功的预测因素。结果：153例患者中，Dara-VTd 85例，VCd 68例。尽管达拉- vtd后的反应更深(≥VGPR 81% vs. 42%；第一次采前p +计数（16 vs. 50/μL）；达拉- vtd和VCd之间的p +产量相当(6.4 vs. 6.0 × 106 CD34+细胞/kg； p =。15)，大多数进行单采的患者达到了目标产率（90%对94%）。Dara-VTd诱导、既往放疗和高肿瘤负荷被确定为活动成功的独立负预测因素。讨论：尽管Dara-VTd诱导与动员动力学受损有关，但成功的稳态动员仍然是可行的。按需使用plerixafor克服了动员缺陷，在接受基于cd38的四联体诱导治疗的患者中支持这种方法。此外，干细胞移植物利用的随访分析表明，在两个队列中，收集但未使用的干细胞移植物的比例很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transfusion 医学-血液学

CiteScore

4.70

自引率

20.70%

发文量

426

审稿时长

1 months

期刊介绍： TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.