Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients.
Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients.
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DOI：
10.1182/blood.v85.2.588.bloodjournal852588
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发表时间：
1995-01
期刊：
影响因子：
20.3
通讯作者：
G. Tricot;S. Jagannath;D. Vesole;J. Nelson;S. Tindle;L. Miller;B. Cheson;J. Crowley;B. Barlogie
中科院分区：
文献类型：
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作者：
G. Tricot;S. Jagannath;D. Vesole;J. Nelson;S. Tindle;L. Miller;B. Cheson;J. Crowley;B. Barlogie
输注高质量的自体外周血干细胞(PBSCs)可确保清髓治疗后快速的造血植入，同时降低与手术相关的发病率和死亡率。我们分析了225名新诊断或难治性多发性骨髓瘤(MM)患者在接受大剂量马法兰(200 mg/m2)支持的自体移植后，影响植入动力学的变量，从而反映了PBSC收集的质量；其中132名患者还完成了第二次移植。所有患者在首次移植前给予大剂量环磷酰胺(6g/m2)和造血生长因子，主要是粒细胞-巨噬细胞集落刺激因子。外周血干细胞单独(91例患者)或与骨髓(134例患者)一起使用。每公斤输注的CD34+细胞数量与粒细胞(P=0.0001)和血小板(P=0.0001)的迅速恢复之间存在高度显著的相关性。对第一次移植前输注或=2×10(6)/kg CD34的患者和或=2.0×10(6)/kg的患者的比例进行校正后，在第一次移植前接受化疗的患者需要大于5×10(6)/kg的CD34细胞以确保快速恢复。在大多数暴露时间较短的患者(91%)中，很容易收集到这样的量，但只有28%的患者在之前接受过24个月的化疗后获得了这样的量。当CD34细胞输注量大于5×10(6)/kg时，血小板在较短时间内(14天前)几乎总是快速恢复(94%)，而当CD34细胞输注量较少时，这一范围逐渐扩大。在没有CD34检测的情况下，大剂量环磷酰胺治疗后14天内血小板迅速恢复至>50×10(9)/L和化疗前12个月内血小板恢复至>50×10(9)/L是预测早期植入的最好指标。对于可能进行自体移植的多发性骨髓瘤患者，建议谨慎使用破坏干细胞的药物，如马法兰和亚硝脲。或者，应该在确诊后及早收集外周血干细胞。
Transfusion of autologous peripheral blood stem cells (PBSCs) of good quality ensures fast hematopoietic engraftment after myeloablative therapy with a decrease in procedure-related morbidity and mortality. We have analyzed variables influencing the kinetics of engraftment, and therefore reflecting the quality of PBSC collections, in 225 patients with newly diagnosed or refractory multiple myeloma (MM) who received an autotransplant in support of high dose melphalan (200 mg/m2); 132 of these patients also completed a second transplant. All PBSCs were collected before the first transplant after high-dose cyclophosphamide (6 g/m2) and hematopoietic growth factors, mainly granulocyte-macrophage colony-stimulating factor. PBSCs were administered either alone (91 patients) or with bone marrow (134 patients). A highly significant correlation was observed between the number of CD34+ cells per kilogram infused and prompt recovery of both granulocytes (P = .0001) and platelets (P = .0001). After correction for the proportion of patients with > or = 2 x 10(6)/kg CD34 PBSCs infused and with or = 2.0 x 10(6)/kg for patients with < or = 24 months of chemotherapy before the first transplant, whereas greater than 5 x 10(6)/kg CD34 cells were required to assure rapid recovery also in those with longer exposure. Such quantities, easily collected in the large majority of patients with shorter exposure (91%), were obtained in only 28% of patients with more than 24 months of prior chemotherapy. Rapid platelet recovery within a narrow range of time (before day 14) was almost invariably seen (94%) when greater than 5 x 10(6)/kg CD34 cells were infused, irrespective of the duration of prior therapy, whereas the range widened progressively when less CD34 cells were infused. In the absence of CD34 measurements, fast recovery of platelets to greater than 50 x 10(9)/L within 14 days after high-dose cyclophosphamide and < or = 12 months of prior chemotherapy were the best predictors of early engraftment. Prudent use of stem cell-damaging agents, such as melphalan and nitrosoureas, is recommended in MM patients who might be candidates for autotransplantation. Alternatively, PBSCs should be collected early after diagnosis.