Abstract
Introduction: High-dose chemotherapy by following autologous stem cell transplant (ASCT) is a standard treatment of multiple myeloma (MM), relapse of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphomas (NHL). Monitoring of clinical and biochemical characteristics, as well as post-transplant parameters, all point to the importance of mobilization potential. Aim: To evaluate the association of early recovery of neutrophil granulocytes ≥0.5 x 109 /L after 11 days of transplantation (ANC500_11), platelets ≥20 x 109 /L after 13 days of transplantation (PLT20_13) with gender, age, duration of mobilization, as well as radiotherapy or chemotherapy, dose CD34+ cells in the apheresis product and therapeutic response. Material and Methods: The retrospective study included 100 patients, out of which 51 patients with MM, 27 with NHL and 22 with HL, in the period from November 2015, ending December 2018. Results: The median age of the patient was 53(20-67) years. According to the DSS, 69% were in IIIA, while 12.5% of patients were in the IIIB clinical stage. According to the Ann-Arbor staging 92% patients were in the II or III clinical stage. The mediana number of CD34+ cells in the apheresis product was 6.7×106 /kgBM. The median in all three mobilization attempts was 6 days. Engraftment is most often detected during the 11th day. In 78% of patients, mobilization was successful in the first attempt (≥2.0x106 /kgBM) among which 86% were MM and 69,4% of lymphomas (p<0.05). The impacts of age, the number of CD34+ cells in the peripheral blood and the duration of the mobilization did not show a significant difference (p>0.05) in relation to the recovery of ANC500_11 and PLT20_13. Conclusion: Satisfactory CD34+ cellular yield can be provided in the first mobilization attempt in most of the patients using of GCS-F, while in the further mobilization attempts plerixafor was necessery. As opposed to gender, age, duration of mobilization and therapeutic response have no impact on ANC500_11 and PLT20_13.
Highlights
High-dose chemotherapy by following autologous stem cell transplant (ASCT) is a standard treatment of multiple myeloma (MM), relapse of Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphomas (NHL)
Za deskriptivnu statistiku korišćene su mere centralne tendencije, apsolutne mere varijacije, za kontinuirane varijable apsolutne frekvencije i procenti za kategoričke varijable; za testiranje značajnosti razlike korićen je χ2 test, a statistički značajnim smatrane su sve vrednosti p < 0,05
Među obolelima od MM najbrojniji (69%) su bili u IIIA stadijumu bolesti (DSS), a u II stadijumu sa prisutnim B-simptomima bilo je 6 bolesnika (12,5%)
Summary
High-dose chemotherapy by following autologous stem cell transplant (ASCT) is a standard treatment of multiple myeloma (MM), relapse of Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphomas (NHL). Prema Ann Arbor klasifikaciji 92% bolesnika je bilo u II ili III stadijumu bolesti. Starosti, broj CD34+ ćelija u perifernoj krvi i dužina mobilizacije nisu pokazali statistički značajnu razliku (p > 0,05) u vezi sa oporavkom ANC500_11 i PLT20_13. Autologna transplantacija matičnih ćelija hematopoeze (ATMĆH) predstavlja standard u lečenju pacijenata sa MM i relapsu limfoma nakon prethodne primene visokodozne hemioterapije. Efikasnost mobilizacije CD34+ matičnih ćelija utiče na broj neophodnih leukafereza, kao i na sam uspeh transplantacije (7). Primena ovog leka je izuzetno značajna kod pacijenata koji su nakon standardne primene G-CSF imali slab prinos matičnih ćelija. 6 do Mobilizacija CD34+ ćelija u perifernoj krvi 11 sati pre afereze, a nakon [4,5,6] dana od primene G-CSF-a. Transplantacija je izvršena u roku od 4 do 6 nedelja posle poslednje afereze
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