High D‐index during mobilization predicts poor mobilization of CD34+ cells after anti‐lymphoma salvage chemotherapy
High D‐index during mobilization predicts poor mobilization of CD34+ cells after anti‐lymphoma salvage chemotherapy
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动员期间高 D 指数预示抗淋巴瘤挽救化疗后 CD34+ 细胞动员不良
DOI：
10.1002/jca.21943
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发表时间：
2021
影响因子：
1.5
通讯作者：
Kurokawa Mineo
中科院分区：
文献类型：
--
作者：
Ebisawa Kazutoshi;Honda Akira;Chiba Akira;Masamoto Yosuke;Okazaki Hitoshi;Kurokawa Mineo
背景动员化疗后进行干细胞采集是抗肿瘤效果和有效采集 CD34+ 细胞之间的一种平衡策略，但深且长时间的最低点使患者面临发热性中性粒细胞减少症的风险。已知发热性中性粒细胞减少症与 CD34+ 细胞产量较低有关，但缺乏涉及 CD34+ 细胞产量与中性粒细胞减少症严重程度之间关联的定量数据。我们假设 D-index 是为定量评估中性粒细胞减少症的严重程度（特别是在血液系统恶性肿瘤领域）而开发的，可以预测 CD34+ 细胞的产量。 方法我们对接受 ESHAP 或改良 ESHAP 动员的复发性或难治性侵袭性淋巴瘤患者进行单中心回顾性分析。我们评估了首次血浆分离术时 CD34+ 细胞产量与 D-index 之间的关联。结果纳入了 36 名患者，我们证明 D-index 较高患者的 CD34+ 细胞产量显着低于 D-index 较低患者。多元线性回归分析和逻辑回归分析也证明了D指数的显着预测能力。此外，在开始动员化疗之前，D-指数与血小板计数显着相关。众所周知，血小板计数可以预测CD34+细胞的产量，血小板计数与D-指数相结合可以识别CD34+细胞产量最低的患者。结论D-指数可以预测CD34+细胞的产量，并且其预测能力似乎不低于血小板计数。需要包括更多异质性患者的前瞻性研究来验证我们的研究。
BackgroundPerforming stem cell collection after mobilization chemotherapy was a well‐balanced strategy between anti‐tumor effect and efficient collection of CD34+ cells, but deep and prolonged nadir exposed patients to risk of febrile neutropenia. Febrile neutropenia was known to be associated with lower yields of CD34+ cells, but quantitative data referring to association between yields of CD34+ cells and severity of neutropenia was lacking. We hypothesized that D‐index, which was developed for quantitative evaluation of severity of neutropenia especially in the field of hematologic malignancies, could predict yields of CD34+ cells.MethodsWe performed a single center, retrospective analysis of patients with relapsed or refractory aggressive lymphoma who were mobilized with ESHAP or modified ESHAP. We evaluated the association between yields of CD34+ cells at first apheresis and D‐index.ResultsThirty‐six patients were included, and we demonstrated that yields of CD34+ cells from patients with higher D‐index were significantly lower than those from patients with lower D‐index. Multivariate linear regression analysis and logistic regression analysis also demonstrated the significant predictive power of D‐index. Further, D‐index was significantly correlated to platelet count before starting mobilization chemotherapy. Platelet count was known to predict yields of CD34+ cells, and combination of platelet count and D‐index could identify patients with lowest CD34+ yields.ConclusionD‐index could predict yields of CD34+ cells and it seemed that its predictive power was not less than that of platelet count. Prospective studies including more heterogeneous patients were needed to validate our study.
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