Application study of EAC mobilization scheme in autologous hematopoietic stem cell transplantation of lymphoma

doi:10.3760/cma.j.cn371439-20200713-00132

Abstract

Abstract:

Objective To explore the safety and efficacy of EAC [etoposide+cytarabine+cyclophosphamide (CTX)] mobilization scheme for mobilizing stem cells in patients with lymphoma undergoing autologous hematopoietic stem cell transplantation (ASCT). Methods A total of 36 patients with lymphoma who had collected peripheral blood stem cells through EAC or CTX+granulocyte colony stimulating factor (G-CSF) mobilization scheme in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2018 to March 2020 were retrospectively analyzed. Among them, 16 patients used EAC mobilization (EAC group), and 20 patients used CTX (CTX group). When white blood cells≤1.0×10 ⁹/L, G-CSF (10 μg/kg per day) was given subcutaneously in two doses. The changes of hematology indexes, the number of collected cells, adverse reactions during mobilization collection and hematopoietic reconstitution after ASCT were observed. Results The peripheral blood stem cells were collected on 5 d (3-8 d) after EAC+G-CSF mobilization and 7 d (4-12 d) after CTX+G-CSF mobilization. The success rates of collection in the EAC group and CTX group were 100% (16/16) and 75.0% (15/20) respectively, the high-quality collection rates were 87.5% (14/16) and 25.0% (5/20) respectively, and there were statistically significant differences (P=0.041; P<0.001). The median of CD34 ⁺ cells of the two groups was 13.67×10⁶/kg and 3.45×10⁶/kg respectively, the median of mononuclear cells was 7.16×10⁸/kg and 5.09×10⁸/kg respectively, the median of CD34⁺ cells/mononuclear cells was 1.44% and 0.67% respectively, and there were statistically significant differences (Z=-4.219, P<0.001; Z=-2.118, P=0.034; Z=-3.104, P=0.002). In the EAC group and CTX group, the incidences of grade 3 and above granulocytopenia were 100% (16/16) and 90.0% (18/20) respectively, the incidences of grade 3 and above hemoglobin reduction were 43.8% (7/16) and 25.0% (5/20) respectively, the incidences of grade 3 and above thrombocytopenia were 87.5% (14/16) and 65.0% (13/20) respectively, and there were no statistically significant differences (P=0.492; P=0.298; P=0.245). There were no significant differences in the incidences of infection, adverse reactions of digestive system or other adverse reactions between the two groups (all P>0.05). All patients accepted improved Bucy scheme before ASCT. The median implantation time of neutrophils and platelets was 9.0 d and 10.5 d in the EAC group, which was 12.0 d and 13.5 d in the CTX group, and there were statistically significant differences (Z=-4.698, P<0.001; Z=-3.757, P<0.001). Conclusion EAC mobilization scheme can significantly increase the number of hematopoietic stem cell. This scheme has a high success rate of high-quality collection and the adverse reactions are within the controllable range. It provides a high-quality mobilization scheme for hematopoietic stem cell mobilization and collection, which is worthy of clinical promotion and application.

Key words: Lymphoma, EAC mobilization scheme, Peripheral blood stem cell collection, Autologous hematopoietic stem cell transplantation, Hematopoietic reconstitution

Chen Lina, Guo Zhi, Liu Xuanyong, Chen Xiao, Zhang Yihuizhi, Li Xumian, Wei Liya, Wang Yueqiao, Xie Jing. Application study of EAC mobilization scheme in autologous hematopoietic stem cell transplantation of lymphoma[J]. Journal of International Oncology, 2021, 48(11): 666-672.

Figures/Tables 4

References 18

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一般资料	EAC组 (n=16)	环磷酰胺组 (n=20)	χ²/Z值	P值	一般资料	EAC组 (n=16)	环磷酰胺组 (n=20)	χ²/Z值	P值
性别					全身症状^a
男	12(75.0)	11(55.0)	-	0.301		无	9(56.3)	13(65.0)	-	0.734
女	4(25.0)	9(45.0)				有	7(43.8)	7(35.0)
年龄(岁)						是否骨髓浸润
≤50	11(68.8)	13(65.0)	-	0.549		是	4(25.0)	2(10.0)	-	0.374
>50	5(31.3)	7(35.0)				否	12(75.0)	18(90.0)
淋巴瘤类型						动员前疾病状态
HL	3(18.8)	2(10.0)				完全缓解	10(62.5)	16(80.0)	-	0.285
DLBCL	7(43.8)	9(45.0)				部分缓解	6(37.5)	4(20.0)
MCL	3(18.8)	4(20.0)	1.407	0.989		动员前化疗次数
HGBL	1(6.3)	2(10.0)				≤4次	5(31.2)	6(30.0)	-	0.609
PTCL	1(6.3)	2(10.0)				>4次	11(68.8)	14(70.0)
PMBL	1(6.3)	1(5.0)				动员前环磷酰胺使用次数
Ann Arbor分期						动员前环磷酰胺使用次数
Ⅳ期	11(68.8)	16(80.0)				≤4次	9(56.3)	8(40.0)	-	0.503
Ⅲ期	1(6.3)	2(10.0)	-0.880	0.379		>4次	7(43.8)	12(60.0)
Ⅱ期	2(12.5)	1(5.0)				G-CSF使用天数
Ⅰ期	2(12.5)	1(5.0)				≤4 d	13(81.3)	5(25.0)	-	0.002
						>4 d	3(18.8)	15(75.0)

项目	EAC组(n=16)	环磷酰胺组(n=20)	Z值	P值
CD34⁺细胞数	13.67(5.85,45.56)×10⁶/kg	3.45(1.92,4.95)×10⁶/kg	-4.219	<0.001
单个核细胞数	7.16(5.60,12.34)×10⁸/kg	5.09(3.87,8.14)×10⁸/kg	-2.118	0.034
CD34⁺细胞/单个核细胞数	1.44%(0.70%,4.08%)	0.67%(0.30%,0.98%)	-3.104	0.002
采集成功与否
采集成功	16(100)	15(75.0)	-	0.041
采集失败	0(0)	5(25.0)
采集优良与否
优良	14(87.5)	5(25.0)	-	<0.001
未达优良	2(12.5)	15(75.0)

不良反应	EAC组 (n=16)	环磷酰胺组 (n=20)	Z值	P值
血液系统不良反应粒细胞减少
≤2级	0(0)	2(10.0)	-	0.492
≥3级	16(100)	18(90.0)
血红蛋白下降
≤2级	9(56.2)	15(75.0)	-	0.298
≥3级	7(43.8)	5(25.0)
血小板减少
≤2级	2(12.5)	7(35.0)	-	0.245
≥3级	14(87.5)	13(65.0)
非血液系统不良反应感染
无	7(43.8)	10(50.0)
轻度	7(43.8)	2(10.0)	-0.681	0.496
中度	2(12.5)	4(20.0)
重度	0(0)	4(20.0)
消化系统不良反应
无	11(68.7)	8(40.0)
Ⅰ~Ⅱ级	5(31.3)	9(45.0)	-1.911	0.056
Ⅲ~Ⅳ级	0(0)	3(15.0)
口唇疱疹	1(6.3)	0(0)	-	0.444
水肿	1(6.3)	3(15.0)	-	0.613
乏力	1(6.3)	6(30.0)	-	0.104
转氨酶升高	2(12.5)	2(10.0)	-	0.608
骨痛	2(12.5)	5(25.0)	-	0.426
口唇或四肢麻木	2(12.5)	4(20.0)	-	0.672