Effect of chemotherapy with alkylating agents on the yield of CD34+ cells in patients with multiple myeloma. Results of the Spanish Myeloma Group (GEM) Study.

多发性骨髓瘤 化疗 医学 川地34 肿瘤科 内科学 粒细胞集落刺激因子 祖细胞 造血 干细胞 骨髓 造血干细胞移植 自体干细胞移植 移植 外科 泌尿科 生物 遗传学
作者
Javier de la Rubia,Joan Bladé,Lahuerta Jj,Josep‐María Ribera,Rafael Martínez,Adrián Alegre,José García‐Laraña,Pascual Fernández,Anna Sureda,de Arriba F,D. Carrera,Joan Besalduch,García Boyero R,Palomera Bernal L,Hernández Mt,García Siguero Pr,Javier Pérez‐Calvo,A Alcalá,Casado Lf,Jesús F. San Miguel
出处
期刊:PubMed 卷期号:91 (5): 621-7 被引量:54
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摘要

Although alkylating agents are clearly beneficial in multiple myeloma (MM), their deleterious effect on bone marrow hematopoietic progenitor cells usually precludes their use as front-line therapy in patients scheduled to undergo autologous stem cell transplantation (ASCT). We analyzed the impact of first-line chemotherapy with alkylating agents on stem cell collection in MM patients.Seven hundred and eighty-nine patients included in the Spanish multicenter protocol GEM-2000 underwent mobilization therapy after four courses of alternating VBMCP/VBAD chemotherapy.The mobilization regimens consisted of standard or high-dose granulocyte colony-stimulating factor (G-CSF) in 551 (70%) patients, and chemotherapy and G-CSF in 206 (26%) patients. The CD34+ cell yield was lower than 4x10(6)/kg in 388 patients (49%), and equal or greater than 4x10(6)/kg in 401 patients (51%). Multivariate analysis indicated that advanced age (p<0.0001) and longer interval between diagnosis and mobilization (p=0.012) were the two variables associated with a lower CD34+ cell yield. Significant differences in CD34+ cell yield were not observed between the mobilization regimens. Of the 789 patients included in the protocol, 726 (92%) underwent the planned ASCT, whereas 25 (3%) patients did not because of the low number of CD34+ cells collected. Following ASCT, 0.5x10(9) neutrophils/L could be recovered after 11 days (median time; range, 5-71 days) and 20x10(9) platelets/L could be recovered after 12 days (median time; range, 6-69 days).A short-course of therapy with alkylating agents according to the GEM-2000 protocol was associated with an appropriate CD34+ cell collection, and allowed the planned ASCT to be performed in the majority of MM patients.

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