PEG-rhG-CSF for peripheral blood stem cell mobilization in patients with relapsed or refractory malignant lymphoma
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摘要:
目的 比较聚乙二醇重组人粒细胞集落刺激因子（pegylated recombinant human granulocyte colony stimulating factor，PEGrhG-CSF）与粒细胞集落刺激因子（granulocyte colony stimulating factor，G-CSF）在复发难治恶性淋巴瘤自体外周血造血干细胞动员（peripheral blood stem cell mobilization，PBSCM）及自体外周血造血干细胞移植（autologous peripheral stem cell transplantation，APBSCT）后造血重建中疗效及药物经济学差异。 方法 选择2014年7月至2016年10月上海交通大学附属第一人民医院收治的复发难治恶性淋巴瘤患者15例，应用PEG-rhG-CSF动员（试验组）；选择2013年1月至2015年8月上海交通大学附属第一人民医院收治的复发难治恶性淋巴瘤患者15例，应用G-CSF动员（对照组），进行回顾性分析。 结果 两组患者外周血造血干细胞均动员采集成功，其中试验组和对照组采集物的中位CD34+细胞计数分别为16.2×106/kg和8.9×106/kg（P=0.414）；中位总单核细胞（mononuclear cell，MNC）数量分别为12.4×108/kg和9.9×108/kg（P=0.519）。试验组和对照组的平均动员时间分别为（10.66±1.45）d和（9.33±1.83）d（P=0.234）。动员期间，试验组和对照组的平均粒缺时间分别为（4.20±2.17）d和（3.80±2.04）d（P=0.608）。干细胞回输后，试验组和对照组粒系重建的平均时间分别为（10.14±1.29）d和（10.93±2.69）d（P=0.327）。血小板重建平均时间分别为（10.36±2.27）d和（12.27±3.38）d（P=0.121）。两组在干细胞动员和造血系统重建方面无显著差异。在药物经济学方面，PEG-rhGCSF平均费用明显低于G-CSF，分别为3 960元和（11 479.3±2 401.3）元（P < 0.001）。 结论 PEG-rhG-CSF在复发难治恶性淋巴瘤的自体PBSCM中疗效与传统的G-CSF相当，且可明显降低患者费用，应用前景广泛。 -
关键词:
- 淋巴瘤 /
- 造血干细胞动员 /
- 聚乙二醇重组人粒细胞集落刺激因子 /
- 造血干细胞移植
Abstract:Objective To compare the efficacy and costs of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhGCSF) and granulocyte colony stimulating factor (G-CSF) for hematopoietic stem cell mobilization and hematopoietic recovery after transplantation in patients with relapsed or refractory malignant lymphoma. Methods From July 2014 to October 2016, 15 patients with malignant lymphoma using peripheral blood stem cell mobilization (PBSCM) for autologous peripheral stem cell transplantation (APBSCT) were treated in our institution and enrolled in the PEG-rhG-CSF group (experimental group). We analyzed data from other 15 patients with malignant lymphoma mobilized with G-CSF who were treated in our institution from January 2013 to August 2015 (control group). Results Patients in both groups were successfully mobilized. The median amounts of CD34+ cells collected in the experimental and control groups were 16.2×106/kg and 8.9×106/kg, respectively (P=0.414), and the median amount of mononuclear cell (MNC) was 12.4×108/kg and 9.9×108/kg, respectively (P=0.519). In the experimental and control groups, the mean durations of mobilization were 10.66±1.45 and 9.33±1.83 days (P=0.234), the mean durations of neutropenia during mobilization were 4.20±2.17 and 3.80±2.04 days (P=0.608), the mean durations of absolute neutrophil count recovery after APBSCT were 10.14±1.29 and 10.93±2.69 days (P=0.327), and the mean durations of platelet recovery were 10.36±2.27 and 12.27±3.38 days (P=0.121). Mobilization and hematopoietic recovery after APBSCT were not significantly different between the two groups. The cost was lower in the experimental group than that in the control group (RMB 3, 960 yuan versus RMB 11, 479.3±2, 401.3 yuan). Conclusion High-dose chemotherapy combined with PEG-rhG-CSF is a promising, effective, and low-cost mobilization regimen for patients with relapsed or refractory malignant lymphoma. -
表 1 一般情况
Table 1. Patient characteristics
表 2 动员及采集情况
Table 2. Results at the time of CD34+ harvest
表 3 动员期间细胞恢复及并发症观察
Table 3. Hematopoietic recovery, toxicity, and supportive care after mobilization chemotherapy
表 4 干细胞回输后细胞恢复及并发症观察
Table 4. Stem cell recovery and complication observation after transfusion
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[1] Montoro J, Andreola G, Gardellini A, et al. R-ESHAP plus pegfilgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory diffuse large B-cell lymphoma[J]. Trans Aphere Sci, 2014, 50(3):411-414. doi: 10.1016/j.transci.2014.03.006 [2] Kuan JW, Su AT, Wong SP, et al. A randomized double blind control trial comparing filgrastim and pegfilgrastim in cyclophosphamide peripheral blood hematopoietic stem cell mobilization[J]. Trans Aphere Sci, 2015, 53(2):196-204. doi: 10.1016/j.transci.2015.03.017 [3] Steidl U, Fenk R, Bruns I, et al. Successful transplantation of peripheral blood stem cells mobilized by chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma[J]. Bone Marrow Transplant, 2005, 35(1):33-36. doi: 10.1038/sj.bmt.1704702 [4] Ria R, Reale A, Melaccio A, et al. Filgrastim, lenograstim and pegfilgrastim in the mobilization of peripheral blood progenitor cells in patients with lymphoproliferative malignancies[J]. Clin Exper Med, 2015, 15(2):145-150. doi: 10.1007/s10238-014-0282-9 [5] Schmitt M, Hoffmann JM, Lorenz K, et al. Mobilization of autologous and allogeneic peripheral blood stem cells for transplantation in haematological malignancies using biosimilar G-CSF[J]. Vox sanguinis, 2016, 111(2):178-186. doi: 10.1111/vox.2016.111.issue-2 [6] Philip T, GIuglielm C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma[J]. New England J Med, 1995, 333(23):1540-1545. doi: 10.1056/NEJM199512073332305 [7] Herbert KE, Gambell P, Link EK, et al. Pegfilgrastim compared with filgrastim for cytokine-alone mobilization of autologous haematopoietic stem and progenitor cells[J]. Bone Marrow Transplant, 2013, 48(3):351-356. doi: 10.1038/bmt.2012.145 [8] Vose JM, Crump M, Lazarus H, et al. Randomized, multicenter, openlabel study of pegfilgrastim compared with daily filgrastim after chemotherapy for lymphoma[J]. J Clin Oncol, 2003, 21(3):514-519. doi: 10.1200/JCO.2003.03.040 [9] Rader M. Granulocyte colony-stimulating factor use in patients with chemotherapy-induced neutropenia: clinical and economic benefits[J]. Oncol, 2006, 20(5 Suppl 4):16-21. http://europepmc.org/abstract/med/16736984 [10] Isidori A, Tani M, Bonifazi F, et al. PhaseⅡstudy of a single pegfilgrastim injection as an adjunct to chemotherapy to mobilize stem cells into the peripheral blood of pretreated lymphoma patients[J]. Haematologica, 2005, 90(2):225-231. https://www.researchgate.net/publication/8021787_Phase_II_study_of_a_single_pegfilgrastim_injection_as_adjunct_to_chemotherapy_to_mobilize_stem_cells_into_the_peripheral_blood_of_pretreated_lymphoma_patients [11] Martino M, Laszlo D, Lanza F. Long-active granulocyte colony-stimulating factor for peripheral blood hematopoietic progenitor cell mobilization[J]. Exp Opin Biological Ther, 2014, 14(6):757-772. doi: 10.1517/14712598.2014.895809 [12] Schmitt M, Publicover A, Orchard KH, et al. Biosimilar G-CSF based mobilization of peripheral blood hematopoietic stem cells for autologous and allogeneic stem cell transplantation[J]. Theranost, 2014, 4 (3):280-289. doi: 10.7150/thno.7752 [13] Simona B, Cristina R, Luca N, et al. A single dose of pegfilgrastim versus daily filgrastim to evaluate the mobilization and the engraftment of autologous peripheral hematopoietic progenitors in malignant lymphoma patients candidate for high-dose chemotherapy[J]. Trans Aphere Sci, 2010, 43(3):321-326. doi: 10.1016/j.transci.2010.10.001 [14] Kobbe G, Bruns I, Fenk R, et al. Pegfilgrastim for PBSC mobilization and autologous haematopoietic SCT[J]. Bone Marr Transplant, 2009, 43(9): 669-677. doi: 10.1038/bmt.2009.59 [15] Kim MG, Han N, Lee EK, et al. Pegfilgrastim vs filgrastim in PBSC mobilization for autologous hematopoietic SCT: a systematic review and meta-analysis[J]. Bone Marr Transplant, 2015, 50(4):523-530. doi: 10.1038/bmt.2014.297 [16] Nosari A, Cairoli R, Clapanna D, et al. Efficacy of single dose pegfilgrastim in enhancing the mobilization of CD34+ peripheral blood stem cells in aggressive lymphoma patients treated with cisplatin-aracytincontaining regimens[J]. Bone Marr Transplant, 2006, 38(6):413-416. doi: 10.1038/sj.bmt.1705459 -
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