109例多发性骨髓瘤患者自体外周血造血干细胞动员采集的回顾性分析

A Retrospective Analysis of Autologous Peripheral Blood Hematopoietic Stem Cell Mobilizations and Collections in 109 Multiple Myeloma Patients

目的 研究对比采用环磷酰胺（CTX）联合粒细胞集落刺激因子（G-CSF）和单用G-CSF两组动员方案的采集效率和安全性.方法 回顾分析2004年4月—2015年6月109例多发性骨髓瘤（MM）患者采用CTX联合G-CSF或单用G-CSF动员采集外周血造血干细胞的资料.对比两组动员方案的采集效率和不良反应.结果 109例患者共进行118例次造血干细胞动员采集.109例患者干细胞采集成功率、优良率分别为85.3％、27.5％,获得CD34＋细胞中位数为3.44（1.14～14.23）×10^6/kg.CTX＋G-CSF组和G-CSF组的干细胞采集成功率分别为87.0％和81.2％（P=0.633）.CTX＋G-CSF组和G-CSF组的采集优良率分别为35.1％和9.4％（P=0.006）.CTX＋G-CSF组和G-CSF组获得的CD34＋细胞中位数分别为3.69（1.14～14.23）×10^6/kg和2.79（1.34～6.49）×10^6/kg（P=0.332）.不良反应方面,CTX＋G-CSF组和G-CSF组白细胞减少3级及以上的发生率分别为57.1％和21.9％（P=0.001）.CTX＋G-CSF组和G-CSF组粒细胞减少3级及以上的发生率分别为51.9％和25.0％（P=0.010）.结论 CTX联合G-CSF和单用G-CSF两组动员方案的采集成功率相当,而前者采集优良率优于后者.在安全性上,两组动员方案相当.因此对于MM患者的外周血干细胞采集,CTX＋G-CSF的动员方案优于单用G-CSF.

Objective To compare the collection efficiency and safety of the two regiments of mobilization：cyclophosphamide （CTX） combined with G-CSF and G-CSF alone. Methods Retrospective analysis of peripheral blood stem cell collection data of 109 multiple myeloma patients who were treated with CTX combined with G-CSF or G-CSF alone mobilization from April 2004 to June 2015. The collection efficiency and adverse reactions were compared between the two groups. Results 109 cases of patients have carried out 118 cases of mobilization of hematopoietic stem cell collection. In the 109 cases, successful mobilization rate and good mobilization rate were respectively 85.3% and 27.5%, the median CD34＋ cells harvested was 3.44 （1.14～14.23）＆#215;106/kg. The successful mobilization rate of CTX ＋ G-CSF group and G-CSF group were respectively 87.0% and 81.2%（P=0.633）. The good mobilization rate of CTX ＋ G-CSF group and G-CSF group were respectively 35.1% and 9.4% （P=0.006）. The median of CD34＋ cells obtained from CTX ＋ G-CSF and G-CSF groups were respectively 3.69 （1.14～14.23）＆#215;106/kg and 2.79 （1.34～6.49）＆#215;106/kg （P=0.332）. In terms of adverse reactions, the incidence of leukopenia grade 3 or worse in CTX ＋ G-CSF group and G-CSF group was 57.1% and 21.9%（P=0.001）.The incidence of leukopenia grade 3 or worse in CTX ＋ G-CSF group and G-CSF group was 51.9%and 25.0% （P=0.010）. Conclusion For patients with multiple myeloma, there was no difference in the success rate of CTX combined with G-CSF and G-CSF mobilization regimens, while the former was superior to the latter in good mobilization rate. In terms of safety, the two groups of mobilization programs are equivalent. Therefore, mobilization of CTX ＋ G-CSF is superior to G-CSF alone in peripheral blood stem cell collection in patients with multiple myeloma.