普乐沙福联合G-CSF对多发性骨髓瘤患者造血干细胞动员的预测因素分析  

Analysis of predictive factors for hematopoietic stem cell mobilization by plerixafor plus G-CSF in patients with multiple myeloma

作　　者：杨巧 熊雅琴 韩晓雁[1] 何冬花[1] 郑高锋[1] 蔡真[1] YANG Qiao;XIONG Yaqin;HAN Xiaoyan;HE Donghua;ZHENG Gaofeng;CAI Zhen(Bone Marrow Transplantation Center,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,310003,China)

机构地区：[1]浙江大学医学院附属第一医院骨髓移植中心,杭州310003 [2]台州市第一人民医院血液肿瘤科,浙江台州318020

出　　处：《临床血液学杂志》2023年第7期495-502,共8页Journal of Clinical Hematology

摘　　要：目的:探讨多发性骨髓瘤(multiple myeloma,MM)患者普乐沙福动员自体外周血造血干细胞的影响因素。方法:收集浙江大学医学院附属第一医院骨髓移植中心2018年8月—2021年10月接受普乐沙福联合粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)动员外周血造血干细胞的86例MM患者数据,分析年龄、体重、BMI、既往化疗、既往放疗、基础疾病、动员前疾病状态、动员前基线外周血细胞水平、普乐沙福应用前后(即采集第-1天和采集第1天)外周血各类细胞水平等因素,探讨这些因素对普乐沙福首次动员效率的影响。结果:患者中位年龄57(38~67)岁,中位采集天数2(1~4)d。首次采集成功率为70.9%,动员成功率为88.4%。单因素分析中ISS分期、糖尿病、第-1天外周血CD34^(+)细胞计数(PBCD34)、第1天WBC、第1天/第-1天WBC比(WBC比值)差异有统计学意义(P<0.05)。多因素logistic回归分析模型1中,第-1天PBCD34(OR=1.299,95%CI 1.12~1.51,P=0.001)和ISS分期(OR=0.159,95%CI 0.03~0.90,P=0.037)差异有统计学意义。模型2中第1天WBC(OR=1.037,95%CI 1.00~1.07,P=0.043),WBC比值(OR=7.553,95%CI 1.06~53.76,P=0.043)和ISS分期(OR=0.112,95%CI 0.03~0.49,P=0.004)差异有统计学意义。结论:单因素分析中ISSⅢ期、合并糖尿病、第-1天PBCD34<3.5/μL、第1天WBC<38×10^(9)/L、WBC比值<1.4是首次采集的不良影响因素。在多因素分析预测模型中,第-1天PBCD34仍是动员的独立预测因素。Objective:To identify the factors associated with autologous peripheral blood hematopoietic stem cell(HSC)mobilization after plerixafor administration in patients with multiple myeloma(MM).Methods:A retrospective analysis of 86 patients with newly diagnosed MM who received plerixafor combined with granulocyte colony-stimulating factor(G-CSF)to mobilize HSC from August 2018 to October 2021 was performed in the Bone Marrow Transplantation Center of the First Affiliated Hospital of Zhejiang University School of Medicine.The factors,such as body weight,BMI,previous chemotherapy regimen,previous radiotherapy,comorbidities,disease status before mobilization,baseline peripheral blood cell level before mobilization,and peripheral blood cell level before and after plerixafor administration(day-1 and day 1 of apheresis),were analyzed to explore the influence on the mobilization efficiency of plerixafor.Results:The median age was 57(38-67)years.The median apheresis days were 2(1-4)days.In univariate analysis,ISS stage,diabetes,peripheral blood CD34^(+)cell count on day-1(day-1 PBCD34),day 1 WBC count,and the ratio of day 1 WBC count/day-1 WBC count before mobilization(WBC ratio)were statistically significant(P<0.05).In multivariate logistic regression analysis model 1,day-1 PBCD34(OR=1.299,95%CI 1.12-1.51,P=0.001)and ISS stage(OR=0.159,95%CI 0.03-0.90,P=0.037)has statistical significance.In model 2,statistically significant associations were observed in day 1 WBC count(OR=1.037,95%CI 1.00-1.07,P=0.043),WBC ratio(OR=7.553,95%CI 1.06-53.76,P=0.043),and ISS stage(OR=0.112,95%CI 0.03-0.49,P=0.004).Conclusion:In univariate analysis,ISS stageⅢ,diabetes,day-1 PBCD34<3.5/μL,day 1 WBC count<38×10^(9)/L,and WBC ratio<1.4 were risk factors of poor mobilization on first leukaphereses.In multivariate analysis prediction model,day-1 PBCD34 was still an independent predictor of mobilization.

关 键 词：多发性骨髓瘤 造血干细胞动员 自体造血细胞移植 普乐沙福 外周血干细胞 

分 类 号：R733.3[医药卫生—肿瘤]