Uticaj primenjene doze CD34+ ćelija na preživljavanje bolesnika sa Hodgkin-ovim limfomom i multiplim mijelomom nakon autologne transplantacije matičnih ćelija

  • Milena Todorović Balint Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Jelena Bila Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Bela Balint Serbian Academy of Science and Arts, Belgrade, Serbia
  • Jelena Jeličić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Irena Djunić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Darko Antić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Nada Kraguljac Kurtović Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
  • Dragana Vujić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Biljana Mihaljević Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180808160T
Ključne reči: hematološke neoplazme, matične ćelije, transplantacija, autologna, preživljavanje, citometrija, protočna

Sažetak


Uvod/Cilj. Autologna transplantacija matičnih ćelija (ATMĆ) poboljšava učestalost ukupnog preživljavanja (UP) kod bolesnika sa hematološkim malignitetima kao što su multipli mijelom (MM) nakon indukcione hemoterapije, agresivni non-Hodgkin-ovi limfomi (NHL) i recidivantni hemiosenzitivni Hodgkin-ov limfom (HL). Cilj ove studije je bila procena uticaja primenjene doze CD34+ ćelija na klinički ishod, kao i na rano post-transplantacijsko i UP bo­lesnika sa Hodgkin-ovim limfomom i multiplim mijelo­mom posle ATMĆ. Metode. Ova studija obuhvatila je ukupno 210 bolesnika (90 HL/120 MM) koji su bili lečeni primenom ATMĆ. Mobilizacija matičnih ćelija (MĆ) izve­dena je pomoću stimulišućeg faktora granulocitnih kolonija (G-CSF) [10–16 μg/kg telesne mase (tm)] posle hemiotera­pije. Za dokazane "slabe-mobilizatore" izvedena je dodatna mobilizacija upotrebom G-CSF (16 μg/kgtm) uz dodatak Plerixafora (24 ili 48 mg). Po našem saznanju, ovo je bila prva primena Plerixafora u našoj zemlji u okvirima ATMĆ. Prikupljanje ćelija je započeto jedino pri graničnoj, odnosno "cut-off" vrednosti CD34+ ≥ 20 /μL u perifernoj krvi, sa "ciljnom dozom" CD34+ ≥ 5 × 106/kg telesne mase (tm) ćelija u afereznom produktu (harvest). Broj CD34+ ćelija i vijabilnost bili su određivani primenom protočne citome­trije. Rezultati. Većini bolesnika sa HL (76,7%) infundo­vano je > 5,0 × 106/kgtm CD34+ ćelija, dok je 68,3% MM bolesnika tretirano dozom od 4,0–5,4 × 106/kg tm CD34+ ćelija. Povoljan terapijski odgovor (potpuna/parcijalna re­misija) postignut je kod 83,3% (HL) i 94,2% bolesnika (MM). Od parametara koji su individualno uticali na preživljavanje bole­snika sa HL i povoljan odgovor na terapiju, multivarijantna analiza (status pre ATMĆ, primenjena doza CD34+ ćelija, rani oporavak hematopoeze, tj. oporavak limfocita i trom­bocita) ukazali su na to da primena većih doza CD34+ ćelija, zajedno sa karakteristikama pre ATMĆ, pozitivno korelira sa boljim preživljavanjem i izostanakom neželjenih događaja (IND), kao i UP posle ATMĆ. Kod bolesnika sa MM, mul­tivarijantna analiza (oštećenje bubrega, doza primenjenih CD34+ ćelija, rani oporavak trombocita) pokazala je da je broj infundovanih CD34+ ćelija najznačajniji parametar koji ima uticaja na IND i UP bolesnika posle ATMĆ. Zaključak. Podaci dobijeni u ovoj studiji neosporno uka­zuju na to da je infundovana doza CD34+ ćelija nezavisan faktor koji može doprineti boljem kliničkom ishodu i UP bolesnika sa HL i MM posle ATMĆ.

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Objavljeno
2021/04/08
Broj časopisa
Vol. 77 Br. 8 (2020): Vojnosanit pregl
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Originalni članak