Mobilization of CD34+ cells in elderly patients (≥ 70 years) with multiple myeloma:: influence of age, prior therapy, platelet count and mobilization regimen
Mobilization of CD34+ cells in elderly patients (≥ 70 years) with multiple myeloma:: influence of age, prior therapy, platelet count and mobilization regimen
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DOI：
10.1046/j.1365-2141.2003.04107.x
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发表时间：
2003-02-01
影响因子：
6.5
通讯作者：
Tricot, G
中科院分区：
文献类型：
--
作者：
Morris, CL;Siegel, E;Tricot, G
研究了984例多发性骨髓瘤患者外周血干细胞的动员情况，其中106例患者年龄大于或等于70岁。年龄增加与CD34（+）产率呈负相关（P < 0.0001），但也与既往标准化疗≥12个月（P = 0.0001）、血小板< 200 × 10(9) /l （P = 0.0006）的预动员和仅使用生长因子的动员（P = 0.0001）呈负相关。在控制了这些年龄协变量后，多变量分析发现少于或等于12个月的标准治疗和血小板计数大于或等于200 × 10(9) /l的预动员是有利变量（P < 0.0001），而增加患者年龄仍然是不利因素（P = 0.0009）。在这两个有利的变量中，85%的老年患者在一次收集的中位数中收集的CD34（+）细胞大于或等于4 × 10(6) /kg。年龄的影响是递增的，没有年龄阈值，显示CD34（+）产量的下降加速。与仅使用生长因子相比，化疗可显著提高CD34（+）的产量。然而，治疗前12个月>且动员前血小板计数< 200 × 10(9) /l的患者亚组，单独使用粒细胞集落刺激因子（G-CSF）动员的CD34（+）细胞与化疗和造血生长因子动员的一样多。增加患者年龄对移植后中性粒细胞恢复没有影响，但如果输注< 2 × 10(6) /kg CD34（+）细胞，则明显延迟血小板恢复（大于或等于50 × 10(9) /l），但输注大于或等于4 × 10(6) /kg CD34（+）细胞时，这种影响完全消除。即使使用有限的预动员治疗，年龄的增加也会对CD34（+）的产生产生不利影响，这表明早期收集对老年患者很重要。
The mobilization of peripheral blood stem cells was studied in 984 multiple myeloma patients, including 106 patients aged greater than or equal to 70 years. Increasing age correlated inversely with CD34(+) yield (P < 0.0001), but also with greater than or equal to 12 months of prior standard chemotherapy (P = 0.0001), < 200 x 10(9) /l platelets (P = 0.0006) premobilization and mobilization with growth factors only (P = 0.0001). After controlling for these age covariates, multivariate analysis identified less than or equal to 12 months standard therapy and platelet count greater than or equal to 200 x 10(9) /l premobilization as favourable variables (both P < 0.0001), while increasing patient age remained an unfavourable factor (P = 0.0009). With both favourable variables, 85% of elderly patients collected greater than or equal to 4 x 10(6) /kg CD34(+) cells in a median of one collection. The effect of age was incremental with no age threshold showing acceleration in the decline of CD34(+) yield. Chemotherapy significantly increased CD34(+) yield compared with growth factors only. However, the subgroup of patients with > 12 months prior therapy and premobilization platelet count < 200 x 10(9) /l mobilized as many CD34(+) cells with granulocyte colony-stimulating factor (G-CSF) alone as with chemotherapy and haematopoietic growth factors. Increasing patient age had no effect on post-transplant neutrophil recovery, but significantly delayed platelet recovery (greater than or equal to 50 x 10(9) /l) if < 2 x 10(6) /kg CD34(+) cells were infused, but this effect was eliminated completely with infusion of greater than or equal to 4 x 10(6) /kg CD34(+) cells. Increasing age adversely affected CD34(+) yield even with limited premobilization therapy, indicating that early collection is important in elderly patients.