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Abstract：
OBJECTIVE: Multiple myeloma (MM) is the leading indication of autologous hematopoietic stem cell transplantation. The aim of this study was to determine the incidence of mobilization failure and characterize the risk factors associated with poor mobilization (PM) of MM patients in novel therapies era.
METHODS: We conducted a retrospective study of 211 MM patients who received their first peripheral blood stem cells (PBSC) mobilization at our single center. The following data were collected: age, gender, clinical stage, disease status, complete blood cell count, induction regimen, CD34+ cell count in peripheral blood (PB), and PBSC collections.
RESULTS: In addition to conventional drugs, 22 (10.4%) patients received daratumumab containing induction, and 33 (15.6%) patients used plerixafor for poor mobilization (pre-apheresis PB CD34+ cells <20/μL). Failure of collection occurred in 24 (11.4%) patients and was correlated with low white blood cell (WBC), ≥3 cycles of lenalidomide treatment before mobilization, steady-state mobilization and nouse of plerixafor are associated with mobilization failure. Daratumumab-based induction treatment ≥2 courses, albumin >41 g/L before mobilization, and steady-state mobilization were risk factors for PM in subgroups of patients treated with lenalidomide for <3 courses. In addition, Hepatitis B virus infection at baseline, thalassemia and measurable residual disease positivity were recognized as predictive factors for PM in subset of chemo-mobilization patients.
CONCLUSIONS: In addition to some well-recognized risk factors, baseline WBC count and daratumumab exposure ≥2 courses before mobilization were revealed as the predictive factors of mobilization failure, providing consultation for preemptive use of plerixafor.
METHODS: We conducted a retrospective study of 211 MM patients who received their first peripheral blood stem cells (PBSC) mobilization at our single center. The following data were collected: age, gender, clinical stage, disease status, complete blood cell count, induction regimen, CD34+ cell count in peripheral blood (PB), and PBSC collections.
RESULTS: In addition to conventional drugs, 22 (10.4%) patients received daratumumab containing induction, and 33 (15.6%) patients used plerixafor for poor mobilization (pre-apheresis PB CD34+ cells <20/μL). Failure of collection occurred in 24 (11.4%) patients and was correlated with low white blood cell (WBC), ≥3 cycles of lenalidomide treatment before mobilization, steady-state mobilization and nouse of plerixafor are associated with mobilization failure. Daratumumab-based induction treatment ≥2 courses, albumin >41 g/L before mobilization, and steady-state mobilization were risk factors for PM in subgroups of patients treated with lenalidomide for <3 courses. In addition, Hepatitis B virus infection at baseline, thalassemia and measurable residual disease positivity were recognized as predictive factors for PM in subset of chemo-mobilization patients.
CONCLUSIONS: In addition to some well-recognized risk factors, baseline WBC count and daratumumab exposure ≥2 courses before mobilization were revealed as the predictive factors of mobilization failure, providing consultation for preemptive use of plerixafor.
摘要：
目的：多发性骨髓瘤（MM）是自体造血干细胞移植的主要适应症。这项研究的目的是确定新疗法时代MM患者动员失败的发生率，并表征与动员不良（PM）相关的危险因素。
方法：我们对211例MM患者进行了回顾性研究，这些患者在我们的单中心首次接受了外周血干细胞（PBSC）动员。收集了以下数据：年龄，性别,临床分期,疾病状态,全血细胞计数,诱导方案，外周血CD34+细胞计数（PB），和PBSC集合。
结果：除了常规药物，22例(10.4%)患者接受了含有达雷妥单抗的诱导，33例（15.6％）患者使用plerixafor动员不良（单采前PBCD34细胞<20/μL）。收集失败发生在24（11.4％）患者中，并与低白细胞（WBC）相关，动员前≥3个周期的来那度胺治疗，稳态动员和plerixafor的nouse与动员失败有关。基于Daratumumab的诱导治疗≥2个疗程，动员前白蛋白>41g/L，和稳态动员是来那度胺治疗<3个疗程患者亚组PM的危险因素。此外,基线时乙型肝炎病毒感染，在化学动员患者的子集中，地中海贫血和可测量的残留疾病阳性被认为是PM的预测因素。
结论：除了一些公认的风险因素，基线白细胞计数和动员前达雷妥单抗暴露≥2个疗程显示为动员失败的预测因素，为抢先使用plerixafor提供咨询。
方法：我们对211例MM患者进行了回顾性研究，这些患者在我们的单中心首次接受了外周血干细胞（PBSC）动员。收集了以下数据：年龄，性别,临床分期,疾病状态,全血细胞计数,诱导方案，外周血CD34+细胞计数（PB），和PBSC集合。
结果：除了常规药物，22例(10.4%)患者接受了含有达雷妥单抗的诱导，33例（15.6％）患者使用plerixafor动员不良（单采前PBCD34细胞<20/μL）。收集失败发生在24（11.4％）患者中，并与低白细胞（WBC）相关，动员前≥3个周期的来那度胺治疗，稳态动员和plerixafor的nouse与动员失败有关。基于Daratumumab的诱导治疗≥2个疗程，动员前白蛋白>41g/L，和稳态动员是来那度胺治疗<3个疗程患者亚组PM的危险因素。此外,基线时乙型肝炎病毒感染，在化学动员患者的子集中，地中海贫血和可测量的残留疾病阳性被认为是PM的预测因素。
结论：除了一些公认的风险因素，基线白细胞计数和动员前达雷妥单抗暴露≥2个疗程显示为动员失败的预测因素，为抢先使用plerixafor提供咨询。
