自体造血干细胞移植治疗多发性骨髓瘤动员方案的研究进展

Progress in mobilization of autologous hematopoietic stem cell transplantation in treatment of multiple myeloma

骨髓瘤患者动员造血干细胞失败的因素包括高龄、疾病状态、以前使用过美法仑、化疗次数、经历过放疗、采集前外周血CD34＋细胞数低。常用的动员方案包括粒细胞集落刺激因子（G-CSF）、化疗联合G-CSF，一些研究显示后者动员效果可能好于前者，但毒副作用也增加。应依据患者的疾病状态和身体状况选择合适的动员方案。普乐沙福是一种新型动员剂，可用于动员失败的高危患者，能获得良好的动员效果。目前，一些含新动员剂的方案正在临床试验中。

Several factors influence mobilization outcomes, including older age and disease state. The type of prior chemotherapy （melphalan）, a higher number of prior treatment lines, prior irradiation or the CD34＋cell count in peripheral blood before apheresis was applied. Common mobilization regimens consist of monotherapy with G-CSF and chemotherapy ＋G-CSF. The HSC mobilization effect is enhanced in chemotherapy ＋G-CSF compared with G-CSF alone, while its incidence and severity of side effects are increased at the same time. The appropriate mobilization regimen is based on patients＆#39; disease state and physical condition. Plerixafor, a novel agent, can be used to enhance the HSC mobilization effect of G-CSF, especially in poor mobilizers after chemomobilization. Other novel regimens are currently being evaluated in different trials.