三级政府医院自体干细胞移植的模式,重点关注采收前CD34+水平的移植结果

Tuphan Kanti Dolai, Rajib De, Ankita Sen, Shuvra Neel Baul, Sumit Mitra, Subham Bhattacharya, Indrani Mondal, Kaushik Mukhopadhyay, Arnab Chattopadhyay, Shyamali Dutta, Prakas Kumar Mandal
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引用次数: 0

摘要

目的:自体干细胞移植(ASCT)是治疗多种血液病的有效方法。本研究评估了三级保健中心的asct模式和相关因素,包括收获前CD34+干细胞水平,导致移植结果的改善。方法:2009年2月至2020年8月在印度进行了一项回顾性研究。纳入65例因不同血液学恶性肿瘤行ASCT的患者,分析患者的年龄、性别、疾病类型和分期、采血前后CD34+计数、达到血小板/中性粒细胞植入或发热性中性粒细胞减少的时间。计算收获后CD34+剂量。预处理采用粒细胞集落刺激因子(GCSF)±普立沙(Plerixafor)。无进展生存期(PFS)以复发/死亡为终点计算。结果:队列的中位年龄(n=65)为49岁,以男性为主。多发性骨髓瘤是最常见的恶性肿瘤(70.8%[46/65]),需要ASCT。ASCT的中位时间为13个月。所有患者均接受GCSF治疗,17例患者使用Plerixafor治疗,收获前CD34+计数为6个细胞/kg体重(n=65)。中性粒细胞和血小板的中位移植时间分别为11天和12天。1例患者没有移植,因此被排除在分析之外。新鲜收获的干细胞(n=48)与冷冻保存的干细胞(n=17)相比,获得中性粒细胞植入所需的时间显著降低(p=0.02)。血小板植入与采收前后CD34+水平的相关性不显著(p=0.06)。收获后CD34+剂量足够,中性粒细胞减少和随后的发热性中性粒细胞减少的时间显着降低(p=0.009)。发热性中性粒细胞减少发生率为83.1%(54/65)。发热性中性粒细胞减少的中位时间为asct后4天。采前和采后CD34+浓度成正比(pp=0.27)。8例复发,8例死亡。结论:采收后CD34+剂量虽与年龄、性别无关,但与发热性中性粒细胞减少呈负相关。由于收获前和收获后的CD34+水平成正比,收获前的CD34+浓度可以可靠地用于评估植入结果。在PFS为112个月的新鲜干细胞中发现了快速的中性粒细胞植入,并且在男性中更好,确切原因尚不清楚。因此,需要对更多的患者进行随访,以获得准确的图像。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level.

Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level.

Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level.

Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level.

Purpose: Autologous stem cell transplantation (ASCT) is an established therapy for many hematological diseases. This study assessed the pattern of ASCTs at a tertiary care center and associated factors, including pre-harvest CD34+ stem cell levels, leading to improved engraftment outcomes.

Methodology: A retrospective study was conducted in India, between February 2009-August 2020. Patients who underwent ASCT for different hematological malignancies (n=65) were included, and the patients' age, sex, type and stage of disease, pre- and post-harvest CD34+ counts, and time to attain platelet/neutrophil engraftment or febrile neutropenia were analyzed. The post-harvest CD34+ dose was calculated. Pre-conditioning was performed using Granulocyte Colony Stimulating Factor (GCSF)±Plerixafor. Progression-free survival (PFS) was calculated using relapse/death as the endpoint.

Results: The median age of the cohort (n=65) was 49 years, with a male preponderance. Multiple myeloma was the most common malignancy (70.8% [46/65]), requiring ASCT. The median time to ASCT was 13 months. All patients had received GCSF, while Plerixafor was used in 17 patients with a pre-harvest CD34+ count of <10 cells/μL. The median pre-harvest CD34+ concentration and post-harvest CD34+ cell dose was 27.54 cells/μL (n=26) and 5.23×106 cells/kg body weight (n=65), respectively. The median time to engraftment was 11 and 12 days, for neutrophils and platelets, respectively. One patient did not engraft and was excluded from the analysis. The time required to attain neutrophil engraftment was significantly lower (p=0.02) among freshly harvested stem cells (n=48) than that of cryopreserved products (n=17). Platelet engraftment associated with CD34+ pre- and post-harvest levels was not significant (p=0.06). The time to attain neutropenia and subsequent febrile neutropenia was significantly lower with an adequate post-harvest CD34+ dose (p=0.009). Febrile neutropenia was seen in 83.1% (54/65) patients. The median time for febrile neutropenia was 4 days post-ASCT. Pre- and post-harvest CD34+ concentrations were directly proportional to each other (p<0.001). The median PFS was 112 months (n=65). Survival was better in males (median PFS: 112 months) vs. females (median PFS: 59 months) (p=0.27). Eight patients relapsed, and eight patients had died.

Conclusion: Although unrelated to age or sex, the post-harvest CD34+ dose was inversely related to febrile neutropenia. As pre- and post-harvest CD34+ levels were directly proportional, pre-harvest CD34+ concentrations may be reliably used to assess engraftment outcomes. Rapid neutrophil engraftment was noted in fresh stem cells with PFS of 112 months, and was better among males, the exact reason being unknown. Thus, a larger number of patients should be followed up to obtain an accurate picture.

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