Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma.
Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma.
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DOI：
10.1016/j.bbmt.2009.02.011
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发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Giralt S
中科院分区：
文献类型：
--
作者：
Popat U;Saliba R;Thandi R;Hosing C;Qazilbash M;Anderlini P;Shpall E;McMannis J;Körbling M;Alousi A;Andersson B;Nieto Y;Kebriaei P;Khouri I;de Lima M;Weber D;Thomas S;Wang M;Jones R;Champlin R;Giralt S
来那度胺是一种在多发性骨髓瘤患者中显示出巨大活性的药物。然而，研究表明，这种药物会对随后的干细胞收集产生负面影响。为了研究来那度胺是否会损害干细胞动员和收集，我们回顾了接受非格司亭动员的多发性骨髓瘤患者的数据。使用逻辑回归分析评估动员失败的预测因素。在302例骨髓瘤患者中，26例（9%）干细胞动员失败。25%既往接受过来那度胺治疗的患者动员失败，而未接受过来那度胺治疗的患者动员失败率为4%（P <0.001）。在多变量分析中，既往使用来那度胺（比值比，5.9; 95%CI，2.4 - 14.3）和诊断后1年以上动员（比值比，4.6; 95%CI，1.9 - 11.1）与动员失败显著相关。26例非格司亭动员失败的患者中有21例接受了化疗和非格司亭的再动员;在这21例患者中，18例（86%）成功动员并收集了干细胞。在多发性骨髓瘤患者中，既往来那度胺治疗与非格司亭干细胞动员失败相关。化疗和非格司亭的再动员在这些患者中通常是成功的。
Lenalidomide is an agent that has shown great activity in patients with multiple myeloma. However, studies have suggested that this drug negatively affects subsequent stem cell collection. To investigate whether lenalidomide impairs stem cell mobilization and collection, we reviewed data for patients with multiple myeloma who underwent mobilization with filgrastim. Predictors of mobilization failure were evaluated using logistic regression analysis. In 26 (9%) of 302 myeloma patients, stem cell mobilization failed. Mobilization failed in 25% of patients who had previously received lenalidomide, compared with 4% of patients who had not received lenalidomide (P < .001). In a multivariate analysis, prior lenalidomide use (odds ratio, 5.9; 95% CI, 2.4 to 14.3) and mobilization more than 1 year after diagnosis (odds ratio, 4.6; 95% CI, 1.9 to 11.1) were significantly associated with failed mobilization. Twenty-one of 26 patients in whom mobilization with filgrastim failed underwent remobilization with chemotherapy and filgrastim; in 18 (86%) of these 21 patients, stem cells were successfully mobilized and collected. In patients with multiple myeloma, prior lenalidomide therapy is associated with failure of stem cell mobilization with filgrastim. Remobilization with chemotherapy and filgrastim is usually successful in these patients.
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