| ObjectiveInvestigate the differences in clinical characteristics,effectiveness,and safety of various mobilization regimens for peripheral blood hematopoietic stem cell mobilization in patients at our center.MethodsA retrospective analysis was conducted on clinical data of 193 patients who underwent different mobilization regimens for autologous peripheral blood stem cells at Qilu Hospital of Shandong University from January 2012 to December 2022.CD34+cell count,success rate of mobilization(≥2×106/kg),failure rate of mobilization(≤2×106/kg),and high-quality mobilization rate(≥4×106/kg)were collected.The relationship between factors such as gender,age,disease type,pre-mobilization treatment regimen,and different mobilization methods and the collection results were analyzed.The impact of different mobilization regimens on adverse reactions,length of hospital stay,days of apheresis,and economic burden was also compared and analyzed.SPSS 26.0 software was used for statistical analysis of the data.Quantitative data were described using mean ± standard deviation or median with interquartile range and were subjected to normality testing using the Shapiro-Wilk method.For normally distributed data,the t-test was used to compare between two groups,and for non-normally distributed data,the median was used to represent the data,and the Wilcoxon rank sum test was used for comparison between two samples.The Chi-square test was used to compare the age stages,gender,and disease types between different diagnostic stages.P<0.05 indicates statistical significance.Results1.Among the 193 patients who underwent stem cell mobilization at our center,111 were male and 82 were female,with a male-to-female ratio of 1.35:1,and a median age of 49.0(45.0-48.2)years old.There was no significant difference in gender between different mobilization methods(P=0.406).The patients were divided into three age groups(<40 years old,40-60 years old,>60 years old),and the differences between the age groups were not statistically significant(P=0.397).There was no significant difference in disease type between different groups(P=0.406).2.The effects of patient gender,age,and disease type on CD34+cell collection and collection success rate were analyzed.The results showed no significant differences in CD34+cell collection and collection success rate among the different groups(P>0.05).3.Based on different mobilization methods,the patients were divided into a plerixafor group(70 cases)and a chemotherapy mobilization group(123 cases).There was no significant difference in gender,age,or other factors between the two groups(P>0.05).4.The median CD34+cell collection in the plerixafor group was 5.81(6.04-8.42)×106/kg,which was significantly higher than that in the chemotherapy mobilization group(4.03[5.19-7.59]×106/kg)(P=0.016).The median duration of single apheresis in the Plerixafor group was 1.00(1.30-1.60)days,which was significantly shorter than the median duration of 2.00(2.00-2.20)days in the chemotherapy mobilization group(P<0.001).5.During mobilization,there were no cases of granulocyte deficiency in the Plerixafor group,which was significantly lower than the 86 cases(69.9%)in the chemotherapy mobilization group(P<0.001).There were 5 cases of antibiotic use for infection during mobilization in the Plerixafor group,which was significantly lower than the 59 cases in the chemotherapy mobilization group(P<0.001).There was 1 case of blood product transfusion due to anemia or thrombocytopenia in the Plerixafor group,which was significantly lower than the 16 cases in the chemotherapy mobilization group(P=0.014).6.The median hospital stay in the Plerixafor group was 7.00(7.20-8.90)days,which was significantly shorter than the median hospital stay of 19.00(19.50-21.80)days in the chemotherapy mobilization group(P<0.001).The economic cost during mobilization in the Plerixafor group was 80,590(80,181-84,003)yuan,which was significantly higher than the 33,053(33,809-39,520)yuan in the chemotherapy mobilization group(P<0.001)7.In 193 patients who underwent stem cell mobilization,there were a total of 89 multiple myeloma(MM)patients.Among these patients,45(50.6%)had previously received treatment with lenalidomide,while 44(49.6%)had not received any lenalidomide treatment before.Demographic data and relevant patient characteristics are shown in Table 2.There was no significant difference in median age or gender between the two groups(P≥0.05).The length of hospital stay for lenalidomide-treated patients was 14.00(11.80-15.50)days,while it was 18.00(15.71-19.24)days for non-lenalidomide-treated patients,and the difference between the two groups was statistically significant(P<0.05).The median number of CD34+cells collected from lenalidomide-treated patients was 6.90(6.90-10.35)×106/kg,while it was 3.87(3.79-6.02)×106/kg for non-lenalidomide-treated patients,and the difference between the two groups was statistically significant(P<0.05).Among the 45 lenalidomide-treated patients,24 chose to use plerixafor mobilization and 21 did not.The plerixafor group collected a median of 6.77(5.86-9.03)×106/kg CD34+cells,while the chemotherapy mobilization group collected 8.72(6.77-13.26)×106/kg CD34+cells,and there was no statistically significant difference between the two groups(P=0.453).All patients in both groups were successfully mobilized,with excellent mobilization achieved in all patients in the plerixafor group and in 15 patients(71.4%)in the chemotherapy mobilization group,and the difference between the two groups was statistically significant(P=0.007).The median duration of single apheresis was 2.00(1.43-1.91)days for the plerixafor group and 2.00(1.88-2.40)days for the chemotherapy mobilization group,with a statistically significant difference between the two groups(P=0.009).ConclusionPlerixafor is a novel HSC mobilization agent that can inhibit the CXCR4 receptor and block the binding of SDF-1.In autologous hematopoietic stem cell transplantation,plerixafor can effectively promote the mobilization of autologous peripheral blood hematopoietic stem cells,increase the number of autologous peripheral blood hematopoietic stem cells,improve the excellent mobilization rate,shorten hospitalization time,and reduce the number of apheresis days.Plerixafor can alleviate chemotherapy-induced bone marrow suppression and immunosuppression,reduce the incidence of mobilization complications such as neutropenia,infection,anemia,and thrombocytopenia.Compared with the chemotherapy mobilization group,the single-drug cost of plerixafor during hospitalization is higher,and it is necessary to include it in medical insurance reimbursement as soon as possible to reduce mobilization costs.The plerixafor regimen is mainly suitable for hematopoietic stem cell mobilization in autologous transplantation,including NHL and MM patients,and the combination with G-CSF can effectively improve the mobilization efficiency of hematopoietic stem cells.It can also be used for hematopoietic stem cell mobilization in healthy donors with poor response to G-CSF.During the outbreak of the COVID-19 pandemic,stem cell mobilization and collection have posed new challenges,and the plerixafor mobilization regimen is a worthy option. |
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