To explore the optimal mobilization for multiple myeloma (MM) patients, we conducted a prospective trial comparing single-dose etoposide (375 mg/m2for one day) plus G-CSF versus G-CSF alone, followed by risk-adapted plerixafor. After randomization, 27 patients in the etoposide group and 29 patients in the G-CSF alone group received mobilizations. Six (22.2%) patients in the etoposide group and 15 (51.7%) patients in the G-CSF alone group received plerixafor based on a peripheral blood CD34+ cell count of < 15/mm3(p= 0.045). The median count of CD34+ cells collected was significantly higher in the etoposide group (9.5 × 106/kg vs. 7.9 × 106/kg;p= 0.018), but the optimal collection rate (CD34+ cells ≥ 6 × 106/kg) was not significantly different between the two groups (96.3% vs. 82.8%;p= 0.195). The rate of CD34+ cells collected of ≥ 8.0 × 106/kg was significantly higher in the etoposide group (77.8% vs. 44.8%;p= 0.025). Although the rates of grade II–IV thrombocytopenia (63.0% vs. 31.0%;p= 0.031) and grade I–IV nausea (14.8% vs. 0%;p= 0.048) were significantly higher in the etoposide group, the rates of adverse events were low in both groups, with no neutropenic fever or septic shock. Thus, both single-dose etoposide plus G-CSF and G-CSF alone with risk-adapted plerixafor were effective and safe, but the former may be the better option for patients who are expected to receive two or more transplantations.
为探索多发性骨髓瘤患者的最佳动员方案，我们开展了一项前瞻性试验，比较单剂量依托泊苷（375 mg/m²，一日给药）联合粒细胞集落刺激因子与单用粒细胞集落刺激因子，并后续根据风险调整使用普乐沙福的方案。随机分组后，依托泊苷组27例患者与单用粒细胞集落刺激因子组29例患者接受了动员治疗。根据外周血CD34+细胞计数＜15/mm³的标准，依托泊苷组6例（22.2%）患者与单用粒细胞集落刺激因子组15例（51.7%）患者接受了普乐沙福治疗（p=0.045）。依托泊苷组采集的CD34+细胞中位数显著更高（9.5×10⁶/kg对比7.9×10⁶/kg；p=0.018），但两组间最佳采集率（CD34+细胞≥6×10⁶/kg）无显著差异（96.3%对比82.8%；p=0.195）。依托泊苷组CD34+细胞采集量≥8.0×10⁶/kg的比例显著更高（77.8%对比44.8%；p=0.025）。虽然依托泊苷组Ⅱ-Ⅳ级血小板减少症（63.0%对比31.0%；p=0.031）及Ⅰ-Ⅳ级恶心（14.8%对比0%；p=0.048）发生率显著更高，但两组不良事件总体发生率较低，均未出现中性粒细胞减少性发热或感染性休克。因此，单剂量依托泊苷联合粒细胞集落刺激因子与单用粒细胞集落刺激因子联合风险调整的普乐沙福方案均安全有效，但对于预计需接受两次及以上移植的患者，前者可能是更优选择。
肿瘤(癌症)患者之家