硫培非格司亭在血液肿瘤患者外周血造血干细胞动员中的应用及采集影响因素分析

文菁菁; 石林; 许芳; 周巧林; 刘宜平; 苏静; 张亚; 屈玟; 岳静; 梁效功; 胡宏

doi:10.12182/20230560103

硫培非格司亭在血液肿瘤患者外周血造血干细胞动员中的应用及采集影响因素分析

Application of Mecapegfilgrastim for Peripheral Blood Hematopoietic Stem Cell Mobilization in Patients With Hematologic Neoplasms and Analysis of Predictors for Poor Mobilization

摘要

摘要:
目的评估硫培非格司亭用于血液肿瘤患者外周血造血干细胞（peripheral blood hematopoietic stem cell, PBSC）动员的效果，探讨PBSC采集的影响因素。
方法回顾性分析2016年4月–2022年5月在绵阳市中心医院血液科行PBSC动员的病例，比较含硫培非格司亭（硫培组，28例）和含重组人粒细胞集落刺激因子（recombinant human granulocyte colony-stimulating factor, rhG-CSF）（rhG-CSF组，30例）两组的CD34⁺细胞采集成功率，并分析采集失败的影响因素。
结果硫培组和rhG-CSF组CD34⁺细胞采集成功率分别为75.0%和63.3%，CD34⁺细胞采集中位值分别为3.37×10⁶/kg和2.68×10⁶/kg，差异均无统计学意义。经普乐沙福补救的硫培组和rhG-CSF组CD34⁺细胞采集中位值分别为4.23×10⁶/kg和3.26×10⁶/kg，差异无统计学意义。两组在造血系统重建和感染等方面也无明显差异（P>0.05）。多因素分析发现非浆细胞疾病〔比值比（odds ratio, OR）=19.697，95%置信区间（confidence interval, CI）：1.501～258.537，P=0.023〕、采集前贫血（OR=18.571，95%CI：1.354～254.775，P=0.029）、采集前WBC<32×10⁹ L⁻¹（OR=85.903，95%CI：4.947～1491.807，P=0.002）是PBSC采集失败的独立危险因素。
结论硫培非格司亭在血液肿瘤患者中的PBSC动员效果与rhG-CSF相当，且联合普乐沙福动员可行、有效。白血病和淋巴瘤、采集干细胞前贫血及WBC<32×10⁹ L⁻¹的患者PBSC采集失败的可能性大。

Abstract:
Objective To evaluate the efficacy of applying mecapegfilgrastim for peripheral blood hematopoietic stem cell (PBSC) mobilization in patients with hematologic neoplasms, and to investigate the influencing factors of PBSC collection.
Methods Patients who underwent PBSC mobilization in the Department of Hematology, Mianyang Central Hospital between April 2016 and May 2022 were retrospectively analyzed. The CD34⁺ cell collection results of two groups, the mecapegfilgrastim group (n=28), or the PEG group, and the recombinant human granulocyte colony-stimulating factor (rhG-CSF) group (n=30), were compared, and the influencing factors of collection failure were analyzed.
Results The success rates of CD34⁺ cells collection in the PEG group and the rhG-CSF group were 75.0% and 63.3%, respectively (P>0.05). The median CD34⁺ cell counts were 3.37×10⁶/kg and 2.68×10⁶/kg, respectively, showing no significant difference. After combined mobilization with plerixafor, the median counts of CD34⁺ cells collected in the PEG group and rhG-CSF group were 4.23×10⁶/kg and 3.26×10⁶/kg, respectively, showing no significant difference (P>0.05). There was no significant difference in hematopoietic system reconstruction and infections between the two groups (P>0.05). Multivariate analysis found non-plasma cell disease (odds ratio OR=19.697, 95% confidence interval CI: 1.501-258.537, P=0.023), anemia before collection (OR=18.571, 95% CI: 1.354-254.775, P=0.029) and white blood cell count before collection under 32×10⁹ L⁻¹ (OR=85.903, 95% CI: 4.947-1491.807, P=0.002) to be independent risk factors for PBSC collection failure.
Conclusion The effect of PBSC mobilization with mecapegfilgrastim was comparable to that of rhG-CSF in patients with hematologic neoplasms. Furthermore, combined mobilization with plerixafor was feasible and effective. Patients with leukemia or lymphoma, anemia, and WBC<32×10⁹ L⁻¹ before stem cell collection have a high probability of PBSC collection failure.

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