聚乙二醇重组人粒细胞集落刺激因子在复发难治恶性淋巴瘤自体外周血造血干细胞动员中的应用研究

  目的  比较聚乙二醇重组人粒细胞集落刺激因子（pegylated recombinant human granulocyte colony stimulating factor，PEGrhG-CSF）与粒细胞集落刺激因子（granulocyte colony stimulating factor，G-CSF）在复发难治恶性淋巴瘤自体外周血造血干细胞动员（peripheral blood stem cell mobilization，PBSCM）及自体外周血造血干细胞移植（autologous peripheral stem cell transplantation，APBSCT）后造血重建中疗效及药物经济学差异。  方法  选择2014年7月至2016年10月上海交通大学附属第一人民医院收治的复发难治恶性淋巴瘤患者15例，应用PEG-rhG-CSF动员（试验组）；选择2013年1月至2015年8月上海交通大学附属第一人民医院收治的复发难治恶性淋巴瘤患者15例，应用G-CSF动员（对照组），进行回顾性分析。  结果  两组患者外周血造血干细胞均动员采集成功，其中试验组和对照组采集物的中位CD34+细胞计数分别为16.2×106/kg和8.9×106/kg（P=0.414）；中位总单核细胞（mononuclear cell，MNC）数量分别为12.4×108/kg和9.9×108/kg（P=0.519）。试验组和对照组的平均动员时间分别为（10.66±1.45）d和（9.33±1.83）d（P=0.234）。动员期间，试验组和对照组的平均粒缺时间分别为（4.20±2.17）d和（3.80±2.04）d（P=0.608）。干细胞回输后，试验组和对照组粒系重建的平均时间分别为（10.14±1.29）d和（10.93±2.69）d（P=0.327）。血小板重建平均时间分别为（10.36±2.27）d和（12.27±3.38）d（P=0.121）。两组在干细胞动员和造血系统重建方面无显著差异。在药物经济学方面，PEG-rhGCSF平均费用明显低于G-CSF，分别为3 960元和（11 479.3±2 401.3）元（P < 0.001）。  结论  PEG-rhG-CSF在复发难治恶性淋巴瘤的自体PBSCM中疗效与传统的G-CSF相当，且可明显降低患者费用，应用前景广泛。 

PEG-rhG-CSF for peripheral blood stem cell mobilization in patients with relapsed or refractory malignant lymphoma

Objective:To compare the efficacy and costs of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) and granulocyte colony stimulating factor (G-CSF) for hematopoietic stem cell mobilization and hematopoietic recovery after transplantation in patients with relapsed or refractory malignant lymphoma. Methods:From July 2014 to October 2016, 15 patients with malignant lymphoma using peripheral blood stem cell mobilization (PBSCM) for autologous peripheral stem cell transplantation (APBSCT) were treated in our institution and enrolled in the PEG-rhG-CSF group (experimental group). We analyzed data from other 15 patients with malignant lymphoma mobilized with G-CSF who were treated in our institution from January 2013 to August 2015 (control group). Results:Patients in both groups were successfully mobilized. The median amounts of CD34+cells collected in the experimental and control groups were 16.2×106/kg and 8.9×106/kg, respectively (P=0.414), and the median amount of mononuclear cell (MNC) was 12.4×108/kg and 9.9× 108/kg, respectively (P=0.519). In the experimental and control groups, the mean durations of mobilization were 10.66±1.45 and 9.33±1.83 days (P=0.234), the mean durations of neutropenia during mobilization were 4.20±2.17 and 3.80±2.04 days (P=0.608), the mean durations of absolute neutrophil count recovery after APBSCT were 10.14±1.29 and 10.93±2.69 days (P=0.327), and the mean durations of platelet recovery were 10.36±2.27 and 12.27±3.38 days (P=0.121). Mobilization and hematopoietic recovery after APBSCT were not significantly different between the two groups. The cost was lower in the experimental group than that in the control group (RMB 3,960 yuan versus RMB 11,479.3±2,401.3 yuan). Conclusion:High-dose chemotherapy combined with PEG-rhG-CSF is a promising, effective, and low-cost mobilization regimen for patients with relapsed or refractory malignant lymphoma.