56例多发性骨髓瘤患者自体外周血造血干细胞动员方案的临床分析

夏冰; 王超雨; 许雯; 田晨; 赵海丰; 赵智刚; 王晓芳; 王亚非; 于泳; 张翼鷟

doi:10.3969/j.issn.1000-8179.2018.11.061

56例多发性骨髓瘤患者自体外周血造血干细胞动员方案的临床分析

Clinical analysis of autologous peripheral blood hematopoietic stem cell mobilization regimen in 56 multiple myeloma patients

摘要

摘要:
目的旨在比较化疗联合粒细胞集落刺激因子（chemotherapy plus granulocyte cyte colony stimulating factor，G-CSF）与化疗联合G-CSF和粒巨噬细胞集落刺激因子（granulocyte-macrophage colony-stimulating factor，GM-CSF）方案对多发性骨髓瘤（multiple myeloma，MM）患者外周血造血干细胞（peripheral blood stem cell，PBSC）动员、采集及造血重建的影响。
方法回顾性分析56例2008年5月至2016年7月天津医科大学肿瘤医院血液科化疗联合G-CSF或化疗联合G-CSF和GM-CSF动员采集PBSC行自体外周血造血干细胞移植（autologous peripheral blood stem cell transplantation，APBSCT）的MM患者资料。分析患者年龄、性别、疾病类型、临床分期（DS、ISS、R-ISS分期系统）、既往治疗方案和周期数等因素对动员效果及移植后造血重建、发热和抗生素应用等的影响。
结果单因素分析发现女性、ISS分期Ⅲ期、R-ISS分期Ⅱ/Ⅲ期及化疗+G-CSF动员方案的患者采集效果较差（P < 0.05）。年龄≤ 60岁或年龄 > 60岁、疾病类型、DS分期（Ⅰ+Ⅱ/Ⅲ）、动员前化疗次数（≤ 6次或 > 6次）、有无烷化剂治疗史、动员前疾病缓解状态部分缓解（partial response，PR）或完全缓解（complete response，CR）及确诊到动员间隔时间（≤ 18个月或 > 18个月）与采集获得的CD34⁺细胞数及采集成功率无相关性（P > 0.05）。进一步多因素分析结果显示，化疗联合G-CSF和GM-CSF患者较化疗联和GCSF患者采集成功率较高（OR=12.009，95%CI：1.961~73.537），不同动员方案是影响干细胞采集结果的独立预后因素（P=0.007）。所有患者移植后均顺利获得造血重建，无移植相关性死亡。两项动员方案组的造血重建时间及回输后发热、抗生素使用情况差异均无统计学意义（P > 0.05）。
结论化疗联合G-CSF和GM-CSF动员方案采集的成功率较高，而不良反应未见增加，该动员方案可作为MM患者外周血干细胞动员的一项较好选择。

Abstract:
Objective To compare the efficacy between chemotherapy plus granulocyte colony-stimulating factor (G-CSF) and chemotherapy plus G-CSF and granulocyte-macrophage colony-stimulating factor (GM-CSF) for the mobilization of peripheral blood stem cells (PBSC) and hematopoietic recovery after transplantation in patients with multiple myeloma (MM).
Methods A retrospective study of autologous PBSC (APBSC) mobilization data of 56 MM patients who were treated with chemotherapy plus G-CSF or chemotherapy plus G-CSF and GM-CSF from May 2008 to July 2016 in Tianjin Medical University Cancer Institute and Hospital was conducted. The mobilization efficacy and hematopoietic recovery were analyzed.
Results In the univariate analysis, the successful collection rate of a single harvest in women and in patients with ISS stage Ⅲ and R-ISS stage Ⅱ/Ⅲ and treated with chemotherapy plus G-CSF was lower (P < 0.05). However, age (≤ 60 years vs. > 60 years), subtype, D-S staging (Ⅰ+Ⅱ vs. Ⅲ), number of cycles of chemotherapy before mobilization (≤ 6 cycles vs. > 6 cycles), disease phase before mobilization (PR vs. CR), and interval between diagnosis and mobilization (≤ 18 months vs. > 18 months) were not correlated with CD34⁺ cell collection and successful mobilization rates (P > 0.05). In the multivariate model, the successful mobilization rate in patients who received the chemotherapy plus G-CSF and GM-CSF mobilization regimen was higher (OR=12.009, 95% CI=1.961-73.537). The effect of mobilization regimens remained significant (P=0.007). Hematopoietic recovery without transplantation-related mortality occurred successfully in all patients.
Conclusions Chemotherapy plus G-CSF and GM-CSF mobilization regimens can significantly increase the effect of APBSC mobilization and ensure the recovery of hematopoietic function after transplantation. Chemotherapy plus G-CSF and GM-CSF mobilization regimens are safe and effective for mobilizing APBSCs.

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