Autologous transplantation remains the standard of care for eligible multiple myeloma (MM) patients, yet optimal CD34+ cell dose remains unclear. We conducted a retrospective study on MM patients undergoing upfront transplant between 2005 and 2021 and divided them into low (≤2.5 × 106 cells/kg) and high (>2.5 × 106 cells/kg) CD34+ dose groups. We included 2479 patients, 95 in the low CD34+ group and 2384 in the high CD34+ group. Patients in the low CD34+ group were older (63.2 vs 61.1 years, p = 0.013), more often had R-ISS III (19% vs 9%, p = 0.014), received plerixafor (60% vs 35%, p < 0.001) and transplanted after 2009 (88% vs 80%, p = 0.047). Time to neutrophil and platelet recovery was longer in the low CD34+ group. Median PFS and OS were lower in the low CD34+ group (31.6 vs. 43.6 months, p = 0.011 and 76.4 vs. 108.2 months, p < 0.001, respectively). Evaluation of incrementally higher CD34+ dose did not show significant improvement in survival at thresholds >2.5 × 106 cells/kg. Multivariable analysis affirmed that CD34+ >2.5 × 106 cells/kg was associated with better PFS (HR 0.71, p = 0.008) and OS (0.59, p < 0.001). After propensity score matching, a CD34+ dose >2.5 × 106 cells/kg remained a predictor of better OS (0.42, p < 0.001). In conclusion, CD34+ dose >2.5 × 106 cells/kg was associated with improved survival, without any additional benefit at incrementally higher doses.
对于符合条件的多发性骨髓瘤（MM）患者，自体移植仍是标准治疗方案，但最佳的CD34+细胞剂量尚未明确。我们对2005年至2021年间接受一线移植的MM患者进行了回顾性研究，将其分为低剂量（≤2.5×10⁶细胞/kg）与高剂量（>2.5×10⁶细胞/kg）CD34+细胞输注组。研究共纳入2479例患者，其中低剂量组95例，高剂量组2384例。低剂量组患者年龄更大（63.2岁 vs 61.1岁，p=0.013），R-ISS III期比例更高（19% vs 9%，p=0.014），更多使用普乐沙福（60% vs 35%，p<0.001）且多在2009年后接受移植（88% vs 80%，p=0.047）。低剂量组的中性粒细胞与血小板恢复时间更长。该组的中位无进展生存期（PFS）和总生存期（OS）均较低（分别为31.6个月 vs 43.6个月，p=0.011；76.4个月 vs 108.2个月，p<0.001）。对超过2.5×10⁶细胞/kg阈值递增剂量的评估未显示生存率的显著改善。多变量分析证实，CD34+细胞剂量>2.5×10⁶细胞/kg与更好的PFS（HR 0.71，p=0.008）和OS（HR 0.59，p<0.001）相关。经倾向评分匹配后，>2.5×10⁶细胞/kg的CD34+剂量仍是改善OS的预测因素（HR 0.42，p<0.001）。总之，CD34+细胞剂量>2.5×10⁶细胞/kg与生存改善相关，但更高剂量未带来额外获益。
肿瘤(癌症)患者之家