在环磷酰胺、沙利度胺和地塞米松方案诱导的多发性骨髓瘤患者中,单独使用粒细胞集落刺激因子动员祖细胞是否可行?

Edvan de Queiroz Crusoe , Fabiana Higashi , Gracia Aparecida Martinez , José Carlos Barros , Marcelo Bellesso , Marina Rossato , Ana Cinira F. Marret , Carlos Sérgio Chiattone , Vania Tietsch de Moraes Hungria
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引用次数: 3

摘要

背景:环磷酰胺联合沙利度胺诱导适合自体干细胞移植的多发性骨髓瘤患者可能是细胞动员的限制因素。为防止移植过程中的有害影响,可接受的最小动员外周血干细胞计数为2.0 × 106 CD34+细胞/kg。与环磷酰胺等粒细胞集落刺激因子联合使用可克服动员限制。本研究的目的是评估在环磷酰胺、沙利度胺和地塞米松诱导后,使用粒细胞集落刺激因子动员和不使用环磷酰胺动员的CD34+细胞的数量。方法对2009年5月至2013年7月在巴西两个中心接受自体干细胞移植的多发性骨髓瘤患者进行回顾性研究。口服环磷酰胺和沙利度胺诱导剂量分别为1500 mg/月和100-200 mg/天。动员剂量为10-15 mcg/kg粒细胞集落刺激因子加2-4 g/m2环磷酰胺,或单独使用15-20 mcg/kg粒细胞集落刺激因子,持续5天。收集2.0 × 106个CD34+细胞/kg被认为是足够的。结果共分析88例患者;只有18人接受了环磷酰胺治疗。粒细胞集落刺激因子组的中位年龄为58岁(范围:51-62岁),粒细胞集落刺激因子加环磷酰胺组的中位年龄为56.5岁(范围:54-60岁)。52例为男性。duie - salmon分期系统III-A/B 80例(90.9%),国际分期系统2和3分别为38例(44.7%)和20例(23.5%)。接受环磷酰胺治疗的组收集到的祖细胞中位数较高[3.8(范围:3.1-4.4)vs. 3.2(范围:2.3-3.8)](p值= 0.008)。更好的反应或诱导周期数与收集的细胞数没有相关性。结论粒细胞集落刺激因子联合环磷酰胺能提高动员细胞的数量。然而,在两组中,CD34+细胞的中位数足以进行单次自体干细胞移植;在收获期间没有报告有害影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is it feasible to use granulocyte-colony stimulating factor alone to mobilize progenitor cells in multiple myeloma patients induced with a cyclophosphamide, thalidomide and dexamethasone regimen?

Background

Cyclophosphamide plus thalidomide as induction for multiple myeloma patients eligible for autologous stem cell transplantation may be a limiting factor for cell mobilization. The minimum acceptable mobilized peripheral blood stem cell count to prevent deleterious effects during transplantation is 2.0 × 106 CD34+ cells/kg. Combining other treatments to granulocyte-colony stimulating factor, such as cyclophosphamide, could overcome the mobilization limitation. The objective of this study was to assess the number of CD34+ cells mobilized using granulocyte-colony stimulating factor with and without cyclophosphamide after induction with cyclophosphamide, thalidomide and dexamethasone.

Methods

A retrospective study was performed of a cohort of multiple myeloma patients submitted to autologous stem cell transplantations at two Brazilian centers between May 2009 and July 2013. The oral cyclophosphamide and thalidomide induction doses used were 1500 mg/month and 100–200 mg/day, respectively. Mobilization doses were 10–15 mcg/kg granulocyte-colony stimulating factor with 2–4 g/m2 cyclophosphamide, or 15–20 mcg/kg granulocyte-colony stimulating factor alone for 5 days. Collection of >2.0 × 106 CD34+ cells/kg was considered sufficient.

Results

Eighty-eight patients were analyzed; only 18 received cyclophosphamide. The median age was 58 years old (range: 51–62) for the granulocyte-colony stimulating factor group and 56.5 years old (range: 54–60) for granulocyte-colony stimulating factor plus cyclophosphamide group. Fifty-two patients were male. Eighty cases (90.9%) were Durie-Salmon Staging System III-A/B and 38 (44.7%) and 20 cases (23.5%) were International Staging System 2 and 3, respectively. The group that received cyclophosphamide collected a higher median number of progenitor cells [3.8 (range: 3.1–4.4) vs. 3.2 (range: 2.3–3.8)] (p-value = 0.008). No correlation was observed between better responses or number of induction cycles and the number of cells collected.

Conclusion

The number of cells mobilized with granulocyte-colony stimulating factor plus cyclophosphamide was higher. However, in both groups, the median number of CD34+ cells was sufficient to perform a single autologous stem cell transplantation; no deleterious effects were reported during harvesting.

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期刊介绍: A Revista Brasileira de Hematologia e Hemoterapia é um periódico científico de propriedade da Associação Brasileira de Hematologia e Hemoterapia, publicada bimestralmente. A abreviatura de seu título é Rev. Bras. Hematol. Hemoter., que deve ser usada em bibliografias, notas de rodapé e em referências e legendas bibliográficas.
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