PDF(Pubmed)
Abstract：
UNASSIGNED: Autologous hematopoietic stem cell transplantation (ASCT) has become the mainstay treatment for many hematological malignancies and solid tumors. An adequate number of stem cells must be collected for better ASCT outcomes, which is challenging in 5%-30% of patients. To improve mobilization, plerixafor is used along with granulocyte colony-stimulating factor (G-CSF).
UNASSIGNED: We conducted a retrospective single center study involving patients who received plerixafor pre-ASCTs between January 2013 and December 2020 at a tertiary care center in Lebanon. We identified a total of 84 consecutive adult patients. All patients identified were poor mobilizers and have eventually received plerixafor either as pre-emptive use before first apheresis in those with peripheral CD34 + of less than 20 cells/ul, or after failure of first apheresis in those with peripheral stem cells (PSC) >2.0 × 106 cells/Kg.
UNASSIGNED: The median age at ASCT was 52.7 years (22-74) with 61% male predominance. Multiple myeloma was the most prevalent disease 64% followed by Lymphoma 32%. The majority of patients were in complete remission 64% at the time of ASCT. Most patients received proteasome inhibitor-based induction therapy 67% and Melphalan-based conditioning therapy 68%. The median follow-up from ASCT was 9 months (1-59). It was noted that greater body mass index (BMI) is a significant factor for better PSC collection whether premobilization (P = 0.003), or post plerixafor mobilization (P = 0.024). Moreover, Multiple Myeloma patients showed better mobilization using Plerixafor (P = 0.049). Using Plerixafor along with G-CSF in poor mobilizers post G-CSF alone showed a statistically significant increase in the collected PSC mean from 0.67 × 106 cells/Kg to 4.90 × 106 cells/Kg (P < 0.001) with a failure rate only for 12 patients (15%). The infusion of PSC > 2.5 × 106 cells/Kg has shown 3 days decrease in time to platelet engraftment (P = 0.021) and a 36% decrease in progression/relapse rate (P = 0.025).
UNASSIGNED: Plerixafor is effective in increasing the PSC yield in poor mobilizers. Low BMI and hematologic malignancies other than Multiple Myeloma are risk factors for poor mobilization. More studies should be performed to establish more risk factors, helping us to identify poor mobilizers more accurately and initiate plerixafor mobilization early on.
UNASSIGNED: We conducted a retrospective single center study involving patients who received plerixafor pre-ASCTs between January 2013 and December 2020 at a tertiary care center in Lebanon. We identified a total of 84 consecutive adult patients. All patients identified were poor mobilizers and have eventually received plerixafor either as pre-emptive use before first apheresis in those with peripheral CD34 + of less than 20 cells/ul, or after failure of first apheresis in those with peripheral stem cells (PSC) >2.0 × 106 cells/Kg.
UNASSIGNED: The median age at ASCT was 52.7 years (22-74) with 61% male predominance. Multiple myeloma was the most prevalent disease 64% followed by Lymphoma 32%. The majority of patients were in complete remission 64% at the time of ASCT. Most patients received proteasome inhibitor-based induction therapy 67% and Melphalan-based conditioning therapy 68%. The median follow-up from ASCT was 9 months (1-59). It was noted that greater body mass index (BMI) is a significant factor for better PSC collection whether premobilization (P = 0.003), or post plerixafor mobilization (P = 0.024). Moreover, Multiple Myeloma patients showed better mobilization using Plerixafor (P = 0.049). Using Plerixafor along with G-CSF in poor mobilizers post G-CSF alone showed a statistically significant increase in the collected PSC mean from 0.67 × 106 cells/Kg to 4.90 × 106 cells/Kg (P < 0.001) with a failure rate only for 12 patients (15%). The infusion of PSC > 2.5 × 106 cells/Kg has shown 3 days decrease in time to platelet engraftment (P = 0.021) and a 36% decrease in progression/relapse rate (P = 0.025).
UNASSIGNED: Plerixafor is effective in increasing the PSC yield in poor mobilizers. Low BMI and hematologic malignancies other than Multiple Myeloma are risk factors for poor mobilization. More studies should be performed to establish more risk factors, helping us to identify poor mobilizers more accurately and initiate plerixafor mobilization early on.
摘要：
■自体造血干细胞移植（ASCT）已成为许多血液系统恶性肿瘤和实体瘤的主要治疗方法。为了获得更好的ASCT结果，必须收集足够数量的干细胞，这在5%-30%的患者中具有挑战性。为了改善动员，plerixafor与粒细胞集落刺激因子（G-CSF）一起使用。
我们进行了一项回顾性单中心研究，涉及2013年1月至2020年12月期间在黎巴嫩的三级护理中心接受pleerixaforpre-ASCT的患者。我们确定了总共84名连续的成年患者。所有确定的患者都是动员不良的患者，并且最终在外周CD34小于20细胞/ul的患者中，在首次单采术之前接受了plerixafor作为抢先使用，或在外周干细胞（PSC）>2.0×106细胞/Kg的患者中首次单采术失败后。
■ASCT的中位年龄为52.7岁（22-74岁），男性占61%。多发性骨髓瘤是最普遍的疾病64％，其次是淋巴瘤32％。大多数患者在ASCT时完全缓解64％。大多数患者接受基于蛋白酶体抑制剂的诱导治疗67%和基于美法仑的预处理治疗68%。ASCT的中位随访时间为9个月（1-59）。有人指出，更大的体重指数（BMI）是更好的PSC收集的重要因素，无论是预动员（P=0.003），或在plerixa动员后（P=0.024）。此外，多发性骨髓瘤患者使用Plerixafor表现出更好的动员（P=0.049）。使用Plerixafor与G-CSF一起在不良动员剂中单独使用G-CSF后，收集的PSC平均值从0.67×106个细胞/Kg增加到4.90×106个细胞/Kg（P<0.001），仅12名患者（15％）。PSC>2.5×106细胞/Kg的输注显示血小板植入时间减少3天（P=0.021），进展/复发率降低36％（P=0.025）。
■Plerixafor可有效提高不良动员器中的PSC产率。低BMI和多发性骨髓瘤以外的恶性血液病是动员不良的危险因素。应该进行更多的研究以确定更多的风险因素，帮助我们更准确地识别不良动员者，并尽早启动plerixafor动员。
我们进行了一项回顾性单中心研究，涉及2013年1月至2020年12月期间在黎巴嫩的三级护理中心接受pleerixaforpre-ASCT的患者。我们确定了总共84名连续的成年患者。所有确定的患者都是动员不良的患者，并且最终在外周CD34小于20细胞/ul的患者中，在首次单采术之前接受了plerixafor作为抢先使用，或在外周干细胞（PSC）>2.0×106细胞/Kg的患者中首次单采术失败后。
■ASCT的中位年龄为52.7岁（22-74岁），男性占61%。多发性骨髓瘤是最普遍的疾病64％，其次是淋巴瘤32％。大多数患者在ASCT时完全缓解64％。大多数患者接受基于蛋白酶体抑制剂的诱导治疗67%和基于美法仑的预处理治疗68%。ASCT的中位随访时间为9个月（1-59）。有人指出，更大的体重指数（BMI）是更好的PSC收集的重要因素，无论是预动员（P=0.003），或在plerixa动员后（P=0.024）。此外，多发性骨髓瘤患者使用Plerixafor表现出更好的动员（P=0.049）。使用Plerixafor与G-CSF一起在不良动员剂中单独使用G-CSF后，收集的PSC平均值从0.67×106个细胞/Kg增加到4.90×106个细胞/Kg（P<0.001），仅12名患者（15％）。PSC>2.5×106细胞/Kg的输注显示血小板植入时间减少3天（P=0.021），进展/复发率降低36％（P=0.025）。
■Plerixafor可有效提高不良动员器中的PSC产率。低BMI和多发性骨髓瘤以外的恶性血液病是动员不良的危险因素。应该进行更多的研究以确定更多的风险因素，帮助我们更准确地识别不良动员者，并尽早启动plerixafor动员。
