Özcan ÇENELİ, MEHMET ALİ KARASELEK, Kazım ÇAMLI, Atakan TEKİNALP, Sinan DEMİRCİOĞLU

Yatarak veya Ayaktan Uygulanan Granülosit Koloni Uyarıcı Faktör ile Otolog Kök Hücre Mobilizasyonunun Etkinliği ve Güvenliği

Amaç: Otolog hematopoetik kök hücre nakli lenfoma ve miyeloma hastalarının tedavisinde günümüzde sık kullanılan bir tedavi yöntemidir. Bu tedavi yönteminin uygulanabilmesi için öncelikle hastadan yeterli sayıda kök hücrenin toplanması gerekmektedir. Aferez ile güvenli ve etkili mobilizasyon yöntemlerinin gelişimiyle birlikte, hastane dışında kök hücre mobilizasyonu olası durumdadır. Çalışmamızda, miyeloma ve lenfoma hastalarında tek başına granülosit-koloni stimüle edici faktör (G-CSF) ile ayaktan ve hastanede yatarak hematopoetik kök hücre mobilizasyonunun etkinlik ve güvenliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: Elli dördü evde mobilizasyon uygulanan, 35’i hastanede mobilizasyon uygulanan hasta olmak üzere toplam 89 hasta çalışmaya alındı. Ayaktan ve yatarak mobilizasyon grupları etkinlik ve güvenlik yönünden karşılaştırıldı. İstatistiksel analizler Jamovi 1.2.27 yazılımı ile yapıldı. Farklılıkların değerlendirilmesinde Mann-Whitney U ve ki-kare testleri kullanıldı. Mobilizasyonu etkileyen faktörlerin istatistiksel analizi için ise MANCOVA kullanıldı. Bulgular: Üç lökoferez işlemi sonrasında, evde mobilizasyon grubunda ortalama 9,73x106/kg (4,5-16,5) CD34+ hücre, hastanede mobilizasyon grubunda ortalama 11,8x106/kg (3,56-59) CD34+ hücre toplandı (p=0,14). Hiçbir hastada yaşamı tehdit edici bir yan etki gözlenmedi. Derece 1, 2 yan etkiler gözlendi, iki grup arasında anlamlı istatistiksel farklılık yoktu. Sonuç: Bu çalışmada G-CSF ile evde ve hastanede mobilizasyon uygulanan miyeloma ve lenfomalı hasta grupları arasında etkinlik ve güvenlik yönünden anlamlı farklılık saptanmadı. Çalışmamızın sonuçları günümüzdeki Koronavirüs hastalığı-2019 pandemisinde olduğu gibi, otolog transplantasyona ihtiyaç duyan ve özellikle hastaneye yatıştan kaçınan hastalarda g-csf ile ayaktan hasta bazında mobilizasyonun etkin ve güvenli bir şekilde yapılabileceğini göstermektedir.

Effectiveness and Safety of Autologous Stem Cell Mobilization with Granulocyte Colony Stimulating Factor in an Inpatient or Outpatient Setting

Aim: Autologous hematopoietic stem cell transplantation is the most frequently used treatment method in the treatment of lymphoma and myeloma patients. To apply this treatment method, first of all, a sufficient number of stem cells must be collected from the patient. With the development of apheresis methods and safe, effective mobilization methods, it is now possible to collect stem cells in an outpatient manner. In our study, we aimed to compare the efficacy and safety of outpatient based mobilization versus inpatient based mobilization of hematopoietic stem cells with granulocyte-colony stimulating factor (G-CSF) alone in patients with myeloma and lymphoma. Materials and Methods: A total of 89 patients, including 54 patients who underwent outpatient and 35 patients who underwent inpatient based mobilization of stem cells with G-CSF alone were included in the study. Outpatient and inpatient based mobilization groups were compared in termsof efficacy and safety. Statistical analyses were performed with Jamovi 1.2.27 software. The Mann-Whitney U and chi-square tests were used to examine the differences. MANCOVA was used for univariate and multivariate statistical analysis of factors influencing mobilization. Results: Three leukaphereses resulted in the collection of a mean 9.73x106/kg (4.5-16.5) CD34+ cells in the outpatient based mobilization group and a mean 11.8x106/kg (3.56-59) CD34+ cells in the inpatient based mobilization group (p=0.14). Life-threatening side effects were not observed in any of the patients. Grade 1, 2 side effects were observed and there was no significant statistical difference between the two groups. Conclusion: In this study, we found no significant difference in terms of efficacy and safety between the outpatient and the inpatient based mobilization group patients with myeloma and lymphoma who were mobilized with G-CSF. The results of our study show that outpatient based mobilization can be effectively and safely performed with g-csf, especially in patients who need autologous transplantation and avoid hospitalization, as in the current Coronavirus disease-2019 pandemic.

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