Zafer GÖKGÖZ, Ender SOYDAN, Ayla GÖKMEN, Osman İLHAN, Önder ARSLAN, Muhit ÖZCAN

MULTİPLE MYELOMA HASTALARINDA ORTA DOZ SİKLOFOSFOMİD (2.5g /m2 Cy) İLE HEMATOPOETİK KÖK HÜCRE MOBİLİZASYONU SONUÇLARIMIZ

Giriş: Bu çalışmada kliniğimizde takip edilen ve 2,5 g/m2 siklofosfomid(Cy) ve 2*5 µ/kg granülosit koloni stimulan faktör (G-CSF) ile CD34+ kök mobilizasyonu yapılan hastaların verileri retrospektif olarak değerlendirilmiş ve literatüre zıt olarak yetersiz miktarda kök hücre toplandığı saptandığı için raporlanmıştır. Gereç ve Yöntem: Bu çalışma, 2015-2017 yılları arasında multipl miyelom tanısı ile indüksiyon tedavisi sonrası, G-CSF ile başarısız bir mobilizasyon denemesinden sonra 2.5 g / m2 siklofosfomid ve G-CSF ile kök hücre mobilizasyon protokolüne tabi tutulan 14 hastayı içermektedir. Hastaların ortanca yaşı 61,5 idi. Çalışmaya 10 erkek, 4 kadın hasta dahil edildi. CD34 + ön sayımı, 2.5 g / m2 Cy ve G-CSF tedavi protokolü uygulanmış hastaların periferik kanında WBC> 1 * 10 ^ 3 / µL olduğu anda yapıldı. Periferde CD34 + kök hücre sayısı ≥20 / microL olan hastalar mobilizasyon işlemine dahil edildi. Bulgular: Bu retrospektif çalışmaya, 2.5 g / m2 Cy ve G-CSF mobilizasyon protokolü ile periferik kök hücre toplanan 14 hasta dahil edildi. Hastaların büyük çoğunluğu ilk aferez seanslarına ortalama olarak siklofosfamid uygulamasının 12. gününde (9-12 gün) alındı. Kök hücre aferezinin ilk günündeki CD34 + kök hücre sayısı % 21.4'’inde 2x10^6'nın altındaydı (n = 3). Hiçbir hastada 2.5 g / m2 Cy ve G-CSF uygulamasından dolayı mobilizasyon sürecinde komplikasyon yaşanmamıştır. Sonuç: Sonuç olarak, benzer çalışmalara kıyasla kök hücre mobilizasyonu için 2,5 g / m2 Cy ve G-CSF içeren bir mobilizasyon protokolü uygulanan hastalarda daha az yeterli ve daha az başarılı bir mobilizasyon oranı ile karşılaşıldı. Düşük toksisite seviyelerine rağmen, yetersiz mobilizasyon başarı oranı ve hastanede kalış süresinin uzunluğundan dolayı 2.5 g / m2 Cy ve 2*5 µg / kg G-CSF ile mobilizasyon seçeneğinin sadece seçilmiş hastalarda uygulanmamasına karar verildi.

HEMATOPOIETIC STEM CELL MOBILIZATION RESULTS WITH INTERMEDIATE DOSE (2.5 g/m2 Cy) CYCLOPHOSPHOMIDE IN THE MULTIPLE MYELOMA PATIENTS AT OUR INSTITUTE

ntroduction: We have aimed to report the inadequate mobilization outcomes of the multiple myeloma patients who received 2.5 g/m2 cyclophosphomide and 2*5 µ/kg granulocyte colony stimulating factor (G-CSF) for peripheral blood CD34+ stem cell mobilization in this retrospective study. Material and method: This study included 14 patients who received treatment for multiple myeloma between the years 2015 to 2017 and were undergone stem-cell mobilization protocol with 2.5 g/m2 Cy and G-CSF after a failed mobilization attempt with G-CSF. Median age of the patients was 61.5 years. The study included 10 male and 4 female patients. CD34+ precount was performed when WBC> 1 *10^3/µL in the peripheral blood of the patients who were applied the treatment protocol of 2.5 g/m2 Cy and G-CSF. The patients with CD34+ stem cell count ≥20/microL in the peripheral blood were included in the mobilization procedure. Results: Fourteen patients who were undergone peripheral stem cell collection with mobilization protocol of 2.5 g/m2 cyclophosphomide and G-CSF were included in this retrospective study. The patients received their first apheresis session averagely at the 12th day (9-12 days) after the first day of cyclophosphamide administration.The number of the CD34+ stem cells at the first day of collection was below 2x106 in 21.4% (n=3) of the patients.No patient experienced a complication during mobilization process due to administration of 2.5 g/m2 cyclophosphomide and G-CSF. Conclusion: As a consequence, we have encountered a less adequate and successfull mobilization rate in the patients in whom we have administered a mobilization protocol including 2.5 g/m2 cyclophosphomide and G-CSF for stem cell mobilization compared with similar studies. Despite low toxicity levels, we concluded not to apply mobilization option with 2.5 g/m2 Cy and 2*5 µg/kg G-CSF because of low mobilization success rate and consequently prolonged hospital stay length.

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