Improving stem cell mobilization strategies: future directions

被引:167
作者
Bensinger, W. [1 ]
DiPersio, J. F. [2 ]
McCarty, J. M. [3 ]
机构
[1] Univ Washington, Sch Med, Div Oncol, Dept Med, Seattle, WA USA
[2] Washington Univ, Sch Med, Dept Med, Div Oncol, St Louis, MO 63110 USA
[3] Virginia Commonwealth Univ, Med Ctr, Dept Internal Med, Div Hematol Oncol & Palliat Care, Richmond, VA USA
关键词
autologous; stem cell; mobilization; G-CSF; chemotherapy; plerixafor; COLONY-STIMULATING FACTOR; BLOOD PROGENITOR CELLS; NON-HODGKINS-LYMPHOMA; HIGH-DOSE CHEMOTHERAPY; BONE-MARROW-TRANSPLANTATION; PLUS G-CSF; MULTIPLE-MYELOMA PATIENTS; RECOMBINANT HUMAN THROMBOPOIETIN; ENHANCED ENGRAFTMENT PROPERTIES; INDEPENDENT PROGNOSTIC-FACTOR;
D O I
10.1038/bmt.2008.410
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Autologous hematopoietic SCT (auto-HSCT) provides hematopoietic support after high-dose chemotherapy and is the standard of care for patients with multiple myeloma (MM) or chemosensitive relapsed high- or intermediate-grade non-Hodgkin's lymphoma (NHL). However, yields of hematopoietic stem cells vary greatly between patients, and the optimal strategy to mobilize hematopoietic stem cells into peripheral blood for collection has not been defined. Current mobilization strategies consist of cytokines alone or in combination with chemotherapeutic agents. Cytokine-only mobilization regimens are well tolerated, but their utility is limited by suboptimal PBSC yields. When a myelosuppressive chemotherapeutic agent is added to a cytokine mobilization regimen, PBSC collections improve two- to five-fold. This benefit is tempered by increased toxicity, morbidity and resource utilization. All current regimens fail to mobilize sufficient hematopoietic stem cells to proceed to transplantation in 5-30% of patients, necessitating additional mobilization attempts or precluding transplantation, which may negatively affect patient outcomes and survival. Improved strategies to mobilize stem cells would increase the availability of auto-HSCT and optimize engraftment and outcomes in patients with MM or NHL. Novel agents used in conjunction with cytokines have the potential to increase PBSC collections without introducing additional morbidity, thereby improving patient outcomes.
引用
收藏
页码:181 / 195
页数:15
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