New strategies for stem cell mobilization.
New strategies for stem cell mobilization.
复制标题
DOI：
10.4084/mjhid.2012.066
复制
发表时间：
2012
影响因子：
3.2
通讯作者：
Lemoli RM
中科院分区：
文献类型：
--
作者：
Lemoli RM
动员外周血被广泛用作自体干细胞移植（ASCT）的干细胞来源。使用细胞因子，单独或联合化疗（化学动员），是最常用的策略，用于动员和收集PBSCs。然而，相当比例的癌症患者未能动员足够的PBSCs进行ASCT。Plerixafor是一种小分子，可可逆和短暂地破坏趋化因子受体CXCR4与其配体CXCL12（以前称为基质衍生因子1，SDF-1）之间的相互作用，导致CD34+造血干细胞从骨髓（BM）快速释放到PB。Plerixafor最近已被批准用于增强多发性骨髓瘤或非霍奇金淋巴瘤成人患者的PBSC动员，并且已被证明比单独使用G-CSF更有效。对于活动能力差的患者，将哌利沙与化疗加G-CSF联合使用的经验有限。目前的证据表明，对于大多数动员后血液CD34+细胞计数低和/或第一次采集后产量低的患者，加用plerixafor是安全有效的。使用plerixafor可以使循环中的CD34+细胞增加数倍，并且大多数被认为“动员能力差”的患者可以成功收集。总的来说，它的作用机制是诱导CD34+细胞从骨髓快速释放到血液循环中，这使得plerixafor适合于难以动员的患者“先发制人”使用。
Mobilized peripheral blood (PB) is widely used as source of stem cells (PBSCs) for autologous stem cell transplantation (ASCT). The use of cytokines, alone or in combination with chemotherapy (chemomobilization), is the most common strategy applied to mobilize and collect PBSCs. However, a significant proportion of cancer patients fail to mobilize enough PBSCs to proceed to ASCT. Plerixafor is a small molecule that reversibly and transiently disrupts the interaction between the chemokine receptor CXCR4 and its ligand CXCL12 (formerly known as stroma derived factor 1, SDF-1) leading to the rapid release of CD34+ hematopoietic stem cells from the bone marrow (BM) to PB. Plerixafor has been recently approved to enhance PBSC mobilization in adult patients with multiple myeloma or non-Hodgkin lymphoma and has been shown to be more effective than G-CSF alone. There is limited experience on combining plerixafor with chemotherapy plus G-CSF in patients who mobilize poorly. Current evidence suggests that the addition of plerixafor is safe and effective in the large majority of the patients with low blood CD34+ cell count after mobilization and/or poor yield after the first collection(s). Circulating CD34+ cells can be increased by several folds with plerixafor and the majority of the patients considered “poor mobilizers” can be successfully collected. Overall, its mechanism of action inducing the rapid release of CD34+ cells from the BM to the circulation makes plerixafor suitable for the ‘preemptive’ use in patients who are hard-to-mobilize.