Objective: To analyze the results and influential factors of mobilization and harvesting of autologous peripheral blood stem cell in patients with multiple myeloma (MM).
Methods: Retrospective analysis of peripheral blood stem cell collection data [CD34⁺ cells collected, successful mobilization rate (CD34⁺ cells≥2×10⁶/kg body weight), good mobilization rate (CD34⁺ cells≥5×10⁶/kg body weight)] of 149 multiple myeloma patients who were treated with cyclophosphamide (CTX) or E-CHOP (etoposide+ CTX+epirubicin+vindesine+prednisone) chemotherapy combined with G-CSF mobilization from January 1998 to March 2014. The relevance between gender, age, subtype, DS staging, ISS staging, treatment before mobilization, disease status at mobilization, regiment of mobilizationand the collection results was analyzed.
Results: A total of 177 stem cell mobilizations were performed in 149 MM patients, the median CD34⁺ cells harvested were 3.20 (0.13-22.34)×10⁶/kg body weight (BW), successful mobilization rate and good mobilization rate were 74.5% and 27.5%, respectively. The single logistic regression analysis showed that gender, age （>60 ys vs ≤60 ys）, subtype, DS staging (III vs II+I), ISS staging (III vs II+I) and regiment of mobilization (E-CHOP+G-CSF vs ID-CTX+G-CSF) were not correlated with the cell collection or successful mobilization rate (P>0.05). However, successful collection rate of single harvest in old patients (age>60 ys) was lower (P<0.05), andthe good mobilization rate in patients at ISS stage III was lower (P<0.05). The collection results of patients with fewer cycles of treatment (treatment before mobilization ≤6 cycles) and optimal disease status (disease status at mobilization ≥partial remission) were much better. Analysis of logistic factors revealed that treatment efficacy before mobilization affected success rate of collection (P=0.006). Risk of collection failure in patients who received more than 6 cycles of treatment before mobilization was high (OR 3.57, 95% CI 1.45-8.78).
Conclusion: Gender, age, subtype, DS staging, ISS staging and mobilization regimen did not influence MM patients peripheral blood stem cell collection; but old patients may need twice mobilizations to collect sufficiently. Few cycles of treatment and stable disease status before mobilization is favorable to the mobilization and collection of peripheral blood stem cells.
目的: 了解多发性骨髓瘤（MM）患者自体外周血造血干细胞动员采集的状况及影响因素。
方法: 回顾分析1998年1月至2014年3月149例MM患者采用环磷酰胺（CTX）或E-CHOP（依托泊苷+CTX＋表阿霉素+长春地辛＋泼尼松）化疗联合G-CSF动员采集外周血造血干细胞的资料[采集获得CD34+细胞数、成功（获得的CD34+细胞数≥2×106/kg）率、优良（获得的CD34+细胞数≥5×106/kg）率]。分析性别、年龄、疾病类型、DS分期、ISS分期、动员前治疗情况、动员时疾病状态、动员方案等因素与采集结果之间的关系。
结果: 149例患者共进行了177例次动员采集，采集CD34+细胞中位数为3.20（0.13~22.34）×106/kg，采集成功率、优良率分别为74.5%、27.5%。单因素分析显示：性别、年龄（>60岁/≤60岁）、疾病类型、DS分期（Ⅲ/Ⅰ +Ⅱ）、ISS分期（Ⅲ/Ⅰ+Ⅱ）及动员方案（E-CHOP+G-CSF/CTX+ G-CSF）与采集获得CD34+细胞数、采集成功率无相关性（P>0.05），但>60岁的患者单次采集成功率较低（P<0.05），DS Ⅲ期的患者采集优良率较低（P<0.05）；动员前疗程数≤6、动员时疾病状态为部分缓解及以上的患者采集效果较好。动员前治疗情况影响干细胞采集成功率（P=0.006），疗程数>6的患者干细胞采集失败风险高（OR值为3.57, 95%CI 1.45~8.78）。
结论: 性别、年龄、诊断类型、DS分期、ISS分期、动员采用的化疗方案对MM患者外周血干细胞采集成功率无影响，但年龄较大的患者需要两次动员。动员前疗程数较少、动员时相对稳定的疾病状态有利于造血干细胞的动员采集。