PDF(Pubmed)
Abstract：
Daratumumab is being increasingly integrated into first-line multiple myeloma (MM) induction regimens, leading to improved response depth and longer progression-free survival. Autologous stem cell transplantation (ASCT) is commonly performed as a consolidation strategy following first-line induction in fit MM patients. We investigated a cohort of 155 MM patients who received ASCT after first-line induction with or without daratumumab (RVd, n = 110; D-RVd, n = 45), analyzing differences in stem cell mobilization, apheresis, and engraftment. In the D-RVd group, fewer patients successfully completed mobilization at the planned apheresis date (44% vs. 71%, p = 0.0029), and more patients required the use of rescue plerixafor (38% vs. 28%, p = 0.3052). The median count of peripheral CD34+ cells at apheresis was lower (41.37 vs. 52.19 × 106/L, p = 0.0233), and the total number of collected CD34+ cells was inferior (8.27 vs. 10.22 × 106/kg BW, p = 0.0139). The time to recovery of neutrophils and platelets was prolonged (12 vs. 11 days, p = 0.0164; and 16 vs. 14 days, p = 0.0002, respectively), and a higher frequency of erythrocyte transfusions (74% vs. 51%, p = 0.0103) and a higher number of platelet concentrates/patients were required (4 vs. 2; p = 0.001). The use of daratumumab during MM induction might negatively impact stem cell mobilization and engraftment in the context of ASCT.
摘要：
Daratumumab越来越多地纳入一线多发性骨髓瘤（MM）诱导方案，导致改善的反应深度和更长的无进展生存期。自体干细胞移植（ASCT）通常是在适应MM患者的一线诱导后作为巩固策略进行。我们调查了155名MM患者的队列，这些患者在有或没有达雷珠单抗的一线诱导后接受ASCT（RVd，n=110；D-RVd，n=45),分析干细胞动员的差异，单采,和雕刻。在D-RVd组中，在计划的单采手术日期成功完成动员的患者较少(44%与71%,p=0.0029),更多的患者需要使用救援plerixafor(38%vs.28%,p=0.3052)。单采时外周CD34+细胞的中位数计数较低(41.37vs.52.19×106/L,p=0.0233),收集的CD34+细胞总数较差(8.27vs.10.22×106/kg体重,p=0.0139)。中性粒细胞和血小板恢复时间延长（12vs.11天,p=0.0164；和16vs.14天,p=0.0002，分别），和更高的红细胞输血频率(74%vs.51%,p=0.0103），并且需要更多的血小板浓缩物/患者（4vs.2；p=0.001）。在MM诱导过程中使用达雷妥单抗可能会对ASCT背景下的干细胞动员和移植产生负面影响。
