普乐沙福联合G-CSF在浆细胞疾病自体造血干细胞动员中的有效性及安全性

Analysis of the efficacy and safety of plerixafor combined with G-CSF in plasma cell disease mobilization

目的分析普乐沙福联合G-CSF在浆细胞疾病自体造血干细胞中动员的效果及安全性。方法回顾性分析2018年1月至2019年12月在北京大学人民医院使用普乐沙福联合G-CSF进行自体造血干细胞动员的浆细胞疾病患者的基线临床资料、采集成功率及不良反应。结果共纳入49例浆细胞疾病患者,多发性骨髓瘤(MM)39例(79.6%),淀粉样变性8例(16.3%),肾脏意义的单克隆免疫球蛋白沉积病(MGRS)2例(4.1%),肾功能不全16例(32.7%)。其他动员方案既往采集失败患者7例(14.3%)。使用普乐沙福动员后,中位采集次数1(1~3)次,中位采集天数2(1~3)d,一次采集成功47例(95.9%),两次采集累积成功率为100%。在16例肾功能不全的患者中,5例(31.3%)患者第1天采集成功,8例(50%)需要第2天采集,3例(18.8%)需要第3天采集。主要不良反应依次为乏力、失眠、腹痛、腹泻、头晕、关节痛。共37例患者行auto-HSCT,白细胞中位植活时间11(8~13)d,血小板中位植活时间11(9~26)d。结论普乐沙福联合G-CSF用于浆细胞疾病患者自体造血干细胞动员成功率高,不良反应少,即使在肾功能不全的患者中也具有较高的动员成功率。

Objective To analyze the effect and safety of plerixafor combined with G-CSF mobilization in plasma cell disease.Methods The clinical baseline data,success rate of collection,and adverse reactions of consecutive cases of plasma cell disease were analyzed retrospectively,where the patients received plerixafor combined with G-CSF for autologous hematopoietic stem cell mobilization in Peking University People's Hospital from January 2018 to December 2019.Results Forty-nine patients with plasma disease were included,of which 39(79.6%)were multiple myeloma,8(16.3%)were amyloidosis,and 2(4.1%)were monoclonal gammopathy of renal significance.A total of 16 patients(32.7%)had renal insufficiency,and 7 patients(14.3%)had previous collection failure.The median times of apheresis was 1(1-3),median days of apheresis was 2(1-3)days,47 patients(95.9%)were successfully collected for once,and the success rate of collection for twice was 100%after using plerixafor for mobilization.In 16 patients with renal insufficiency,collection was successful in 5 patients(31.3%)on the first day,while aphresis was required in 8 patients(50%)on the second day and 3(18.8%)on the third day.The main adverse reactions were fatigue,insomnia,abdominal pain,diarrhea,dizziness,and arthralgia.A total of 37 patients underwent autologous hematopoietic stem cell transplantation with 11(8-13)days for neutrophil engraftment,and 11(9-26)days for platelet engraftment.Conclusions Plerixafor combined with G-CSF has a high success rate in mobilizaion of autologous hematopoietic stem cells in patients with plasma cell disease with minimum side effects,even in patients with renal insufficiency.