聚乙二醇化重组人粒细胞集落刺激因子用于多发性骨髓瘤自体造血干细胞动员的研究  

Study on pegylated recombinant human granulocyte colony-stimulating factor for mobilization of autologous stem cells in multiple myeloma

作　　者：丁筱[1] 黄文阳 刘雪莲 杨艳萍[1] 樊红琼[1] 岳婷婷 邹德慧 邱录贵 靳凤艳[1] Ding Xiao;Huang Wenyang;Liu Xuelian;Yang Yanping;Fan Hongqiong;Yue Tingting;Zou Dehui;Qiu Lugui;Jin Fengyan(Department of Hematology,the First Hospital of Jilin University,Changchun 130021,China;State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)

机构地区：[1]吉林大学第一医院肿瘤中心血液科,长春130021 [2]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床研究中心,天津300020

出　　处：《白血病．淋巴瘤》2021年第1期17-22,共6页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金面上项目(81670190)。

摘　　要：目的探讨聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)用于多发性骨髓瘤(MM)患者外周血造血干细胞动员(PBSCM)的效果及药物经济学价值。方法回顾性分析2015年1月至2017年10月在吉林大学第一医院和中国医学科学院血液病医院住院治疗的91例初治MM患者资料。根据患者意愿,采用大剂量化疗结合皮下注射PEG-rhG-CSF或重组人粒细胞集落刺激因子(rhG-CSF)进行干细胞动员,分别为42、49例。分析两组动员后采集单个核细胞(MNC)数、采集物CD34+细胞数、动员中最高中性粒细胞(mANC)数、动员的费用以及移植后白细胞和血小板植入时间。结果PEG-rhG-CSF组和rhG-CSF组的中位采集MNC数分别为5.86×10^(8)/kg[(1.08~24.54)×10^(8)/kg]和6.61×10^(8)/kg[(0.83~33.80)×10^(8)/kg],差异无统计学意义(U=883.00,P=0.245);PEG-rhG-CSF组的中位采集物CD34+细胞数高于rhG-CSF组,分别为5.56×10^(6)/kg[(0.94~19.90)×10^(6)/kg]和4.82×10^(6)/kg[(1.12~14.61)×10^(6)/kg],差异有统计学意义(U=732.00,P=0.038)。PEG-rhG-CSF组动员期间中位mANC数较rhG-CSF组低,分别为20.50×109/L[(7.26~61.30)×109/L]和32.08×109/L[(6.92~69.99)×109/L],差异有统计学意义(U=490.00,P=0.001)。自体干细胞移植(ASCT)后,PEG-rhG-CSF组白细胞计数(WBC)恢复至1.0×109/L的时间较rhG-CSF组短[(11.59±1.98)d比(12.93±2.83)d],差异有统计学意义(t=-2.395,P=0.019);PEG-rhG-CSF组血小板计数(Plt)恢复至20.0×109/L的时间也较rhG-CSF组有缩短趋势[(12.86±2.62)d比(14.80±5.47)d],但差异无统计学意义(t=-1.749,P=0.085)。PEG-rhG-CSF组的动员总费用与rhG-CSF组差异无统计学意义[(21405.47±7365.98)元比(22976.83±10264.34)元,t=-0.721,P=0.474]。结论PEG-rhG-CSF联合大剂量化疗是MM患者PBSCM的有效方案,其动员费用与rhG-CSF相当。PEG-rhG-CSF可能是MM患者PBSCM的更好选择。Objective To investigate the efficiency and pharmacoeconomics of pegylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)for mobilization of peripheral blood stem cells(PBSCM)in patients with multiple myeloma(MM).Methods The data of 91 patients with newly treated MM who were hospitalized in the First Hospital of Jilin University and Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College from January 2015 to October 2017 were retrospectively analyzed.According to the patient's wishes,a high-dose chemotherapy combined with subcutaneous injection of PEG-rhG-CSF or recombinant human granulocyte colony-stimulating factor(rhG-CSF)was used for stem cell mobilization in 42 and 49 patients,respectively.The number of mononuclear cells(MNC)and CD34+cells collected after mobilization,the maximum absolute neutrophil count(mANC),the cost of mobilization,and the engraftment time of white blood cells and platelets after transplantation were compared between the two groups.Results The median number of MNC collected after mobilization in the PEG-rhG-CSF group and rhG-CSF group were 5.86×10^(8)/kg[(1.08-24.54)×10^(8)/kg]and 6.61×10^(8)/kg[(0.83-33.80)×10^(8)/kg],and the difference was not statistically significant(U=883.00,P=0.245);while the median number of CD34+cells collected after mobilization in the PEG-rhG-CSF group was higher than that in the rhG-CSF group[5.56×10^(6)/kg(0.94-19.90)×10^(6)/kg and 4.82×10^(6)/kg(1.12-14.61)×10^(6)/kg],and the difference was statistically significant(U=732.00,P=0.038).The median number of mANC during mobilization in the PEG-rhG-CSF group was lower than that in the rhG-CSF group[20.50×109/L(7.26-61.30)×109/L and 32.08×109/L(6.92-69.99)×109/L],and the difference was statistically significant(U=490.00,P=0.001).After autologous stem cell transplantation(ASCT),the time-to-recovery of white blood cell count(WBC)to 1.0×109/L in the PEG-rhG-CSF group was shorter than that in the rhG-CSF group[(11.59±1.98)d vs

关 键 词：多发性骨髓瘤 粒细胞集落刺激因子 重组 造血干细胞动员 造血干细胞移植 

分 类 号：R733.3[医药卫生—肿瘤]