大剂量环磷酰胺联合粒细胞集落刺激因子动员多发性骨髓瘤造血干细胞的价值研究

High-dose cyclophosphamide with granulocyte colony-stimulating factor for mobilization of autologous peripheral blood stem cells in patients with multiple myeloma

目的研究大剂量环磷酰胺（HD—CTX）联合粒细胞集落刺激因子（G—CSF）在多发性骨髓瘤（MM）造血干细胞动员中的临床疗效和安全性。方法选择2006年6月至2010年9月中山大学附属第一医院血液科36例MM患者，全部患者接受HD—CTX联合G—CSF动员，CTX3～5g／m2，第1天，G—CSF300μg/d第2天起直到干细胞采集结束。结果35例（97．2％）动员成功，其中31例第一次动员即成功，4例第二次动员成功。干细胞采集的中位时间为第11（9～13）天，22例（62．9％）患者采集1次，13例（37．1％）患者采集2次。采集的单个核细胞（MNC）数为（4．49±1．71）×10^8／kg，CD34＋细胞数为（3．21±1．87）×10。／kg。7例疗效在动员后得到进一步提高。动员的非血液系统副反应包括恶心、呕口王11例（26．8％）、腹痛腹泻5例（12．2％）、发热7例（17．1％）、骨痛4例（9．8％）等。只有1例因感染影响干细胞采集。结论HD—CTX联合G—CSF是MM造血干细胞动员的安全有效的方法。

Objective To explore the efficacy and safety of high-dose cyclophosphamide （CTX）with granuloeyte colony-stimulating factor for mobilization of autologous peripheral blood stem cells in patients with muhiple myeloma. Methods 36 cases with muhiple myeloma receiced HD-CTX 3 × 5 g/m2 on day 1 and G-CSF 300 txg/d was used on day 2 and given daily subcutaneously until stem cells collection was completed. Results Mobilization was successful in 35/36 （97.2%）patients. Collection was started on days 11 （9 - 13 ）. Enough stem cells was acqired in 22 cases（62. 9% ） by one leukopherese. However, 13 eases（37. 1% ） need twice. The mean number of MNC was（4. 49 ±2 1.71 ）× 10^8/kg and CD34 ＋ was（3.21 ± 1.87 ） × 10^6/kg. The clinical effects of 7/ 35 patients were improved after mobilization. Non-hematological adverse events included nausea and vomiting 11 （26. 8% ） ,diarrhea 5（12. 2% ） ,fever 7（17. 1% ） ,bone pain 4（9. 8% ）. All of these adverse reactions could be controlled with routine supportive treatmemt. Only one failue to mobilization due to infection. Conclusion HD-CTX with granulocyte colony-stimulating factor is an effective and safe mobilizing regimen for autologous peripheral blood stem progenitor cells in patients with multiple myeloma.