依托泊苷联合G-CSF与环磷酰胺联合G-CSF在多发性骨髓瘤患者中进行自体外周血干细胞动员的比较

Comparison of etoposide combined with G-CSF and cyclophosphamide combined with G-CSF in the mobilization of autologous peripheral blood stem cells in patients with multiple myeloma

目的比较依托泊苷(ETO)联合G-CSF与环磷酰胺(CTX)联合G-CSF在多发性骨髓瘤(MM)患者中进行自体外周血造血干细胞动员的效果及安全性。方法纳入2020年1月1日至2023年7月31在首都医科大学附属北京朝阳医院血液科接受自体外周血造血干细胞动员、采集的MM患者,利用倾向性评分按照1∶1匹配比例筛选出134例患者,ETO联合G-CSF动员方案(ETO组)、CTX联合G-CSF动员方案(CTX组)各67例,对其临床资料进行回顾性分析。结果①ETO组、CTX组采集天数分别为2(1~3)d、2(1~5)d(P<0.001),CD34^(+)细胞采集量分别为7.62(2.26~37.20)×10^(6)/kg、2.73(0.53~9.85)×10^(6)/kg(P<0.001),采集成功率分别为100.0%(67/67)、76.1%(51/67)(P<0.001)、采集优良率分别为82.1%(55/67)、20.9%(14/67)(P<0.001)。ETO组有2例患者在采集1 d后进行方案转换,CTX组有11例患者在采集1~2 d后进行方案转换。②ETO组、CTX组粒缺伴发热发生率分别为21.5%(14/65)、10.7%(6/56)(P=0.110),血小板输注患者占比分别为10.7%(7/65)、1.8%(1/56)(P=0.047)。③至随访截止,ETO组63例、CTX组54例患者接受了自体造血干细胞移植,中位CD34+细胞回输量分别为4.62(2.14~19.89)×10^(6)/kg、2.62(1.12~5.31)×10^(6)/kg(P<0.001),中性粒细胞植入时间分别为11(9~14)d、11(10~14)d(P=0.049),血小板植入时间分别为11(0~19)d、12(0~34)d(P=0.035)。CTX组有1例患者发生血小板延迟植入。结论依托泊苷联合G-CSF的动员方案可能有较多的患者需要输注血小板,但采集天数缩短,采集成功率、优良率及CD34+细胞采集量较高,移植后中性粒细胞和血小板植入较快。

Objective The effect and safety of etoposide combined with G-CSF were compared with those of cyclophosphamide combined with G-CSF in autologous peripheral blood mobilization in patients with multiple myeloma(MM).Methods Patients with MM who received autologous peripheral blood stem cell mobilization and collection in the Department of Hematology,Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 1,2020 to July 31,2023 were included.A total of 134 patients were screened by propensity score matching technology according to a 1∶1 ratio.A total of 67 cases were each treated with ETO combined with G-CSF mobilization scheme(ETO group)and CTX combined with G-CSF mobilization scheme(CTX group).Their clinical data were retrospectively analyzed.Results①Collection results:the ETO and CTX groups[2(1-3)d vs 2(1-5)d;P<0.001]and CD34+cells[7.62×10^(6)(2.26×10^(6)-37.20×10^(6))/kg vs 2.73×10^(6)(0.53×10^(6)-9.85×10^(6))/kg;P<0.001]were collected.The success rate of collection was 100.0%(67/67)versus 76.1%(51/67)(P<0.001).Excellent rate of collection was 82.1%(55/67)versus 20.9%(14/67;P<0.001).Two patients in the ETO group switched protocols after 1 day of collection,and 11 patients in the CTX group switched protocols after 1-2 days of collection.②Adverse reactions:granular deficiency with fever(21.5%[14/65]vs.10.7%[6/56];P=0.110),requiring platelet transfusion[10.7%(7/65)vs 1.8%(1/56);P=0.047].③Until the end of follow-up,63 cases in the ETO group and 54 cases in the CTX group have undergone autologous transplantation.The median number of CD34+cells infused in the two groups was 4.62×10^(6)(2.14×10^(6)-19.89×10^(6))/kg versus 2.62×10^(6)(1.12×10^(6)-5.31×10^(6))/kg(P<0.001),neutrophil implantation time was 11(9-14)d versus 11(10-14)d(P=0.049),and platelet implantation time was 11(0-19)d vs.12(0-34)d(P=0.035).One case in the CTX group experienced delayed platelet implantation.Conclusion The mobilization scheme of etoposide combined with G-CSF requires relatively platelet transfusion,but the collection days are shortened.The collection success rate,excellent rate,and the number of CD34+cells obtained are high,and the neutrophil and platelet engraftment is accelerated after transplantation.