非霍奇金淋巴瘤患者自体造血干细胞移植干细胞动员采集现状和疾病负担调查
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摘要
目的分析非霍奇金淋巴瘤(NHL)患者自体造血干细胞移植(Auto-HSCT)的干细胞动员采集现状和疾病负担。方法采用定量调研问卷对国内8个城市共20名资深临床医师进行了面对面访谈。调研问卷的主要内容包括收治患者的状况、干细胞动员采集成功率、治疗费用等。结果单用粒细胞集落刺激因子(G-CSF)和化疗+粒细胞集落刺激因子(CM+G-CSF)是目前常用的两种动员方法。首次动员中,单用G-CSF和CM+G-CSF动员方案的干细胞采集前的平均动员时间分别为5.33 d和7.43 d,采集时间分别为4.44 d和5.68 d,动员成功率分别为45.56%和62.43%,动员总费用分别为33 319元和46 589元。首次动员失败后,61.5%患者选择二次动员,其中单用G-CSF和CM+G-CSF动员方案的干细胞采集前平均动员时间分别为5.67 d和6.54 d,采集时间分别为5.91 d和4.98 d,动员成功率分别为46.50%和50.00%,动员总费用分别为39 897元和41 686元。首次动员失败后,38.5%患者选择包括异基因外周血造血干细胞移植、异基因骨髓造血干细胞移植和挽救疗法,其平均费用分别为(244 000.00±19 089.82)元、(178 975.00±19 768.41)元和(79 400.00±15 449.14)元。结论目前NHL患者单用G-CSF方案和CM+G-CSF方案进行干细胞动员采集的成功率均偏低,增加了患者的疾病经济负担和医疗资源的使用,因此亟待更为有效的干细胞动员采集策略。
Objective To analyze the status quo of mobilization and collection of stem cells for autologous hematopoietic stem cell transplantation in patients with non-hodgkin's lymphoma and disease burden. Methods A face-to-face interview was conducted with 20 clinicians from 8 cities in China, using quantitative questionnaire. The main contents of the questionnaire include the condition of the patients, the success rate of stem cell mobilization, and the cost of treatment, etc. Results Using granulocyte colony-stimulating factor(G-CSF) and chemotherapy plus granulocyte colony-stimulating factor(CM+G-CSF) respectively were the two commonly used mobilization methods. During the first mobilization, the average mobilization time before stem cell collection using G-CSF and CM+G-CSF mobilization schemes was 5.33 d and 7.43 d, respectively, and the acquisition time was4.44 d and 5.68 d. The mobilization success rate was 45.56% and 62.43%, and the total mobilization cost was 33,319 yuan and46,589 yuan, respectively. After the first mobilization failed, 61.5% of the patients chose the second mobilization. The average mobilization time before stem cell collection by G-CSF and CM+G-CSF mobilization programs was 5.67 and 6.54 days respectively.And the acquisition time was 5.91 and 4.98 days respectively. The mobilization success rate was 46.50% and 50.00%, and the total mobilization cost was 39,897 yuan and 41,686 yuan, respectively. After the first mobilization failed, 38.5% of patients chose allogeneic peripheral blood stem cell transplantation, allogeneic bone hematopoietic stem cell transplantation, and salvage therapies.The average cost were 244 000.00±19,089.82 yuan, 178 975.00±19 768.41 yuan and 79 400.00±15 449.14 yuan, respectively.Conclusion At present, the success rates of stem cell mobilization therapies including G-CSF and CM+G-CSF for patients with NHL are low, which will increase the disease economic burden and medical resource utilization. The more effective stem cell mobilization strategy is urgently needed.
Objective To analyze the status quo of mobilization and collection of stem cells for autologous hematopoietic stem cell transplantation in patients with non-hodgkin's lymphoma and disease burden. Methods A face-to-face interview was conducted with 20 clinicians from 8 cities in China, using quantitative questionnaire. The main contents of the questionnaire include the condition of the patients, the success rate of stem cell mobilization, and the cost of treatment, etc. Results Using granulocyte colony-stimulating factor(G-CSF) and chemotherapy plus granulocyte colony-stimulating factor(CM+G-CSF) respectively were the two commonly used mobilization methods. During the first mobilization, the average mobilization time before stem cell collection using G-CSF and CM+G-CSF mobilization schemes was 5.33 d and 7.43 d, respectively, and the acquisition time was4.44 d and 5.68 d. The mobilization success rate was 45.56% and 62.43%, and the total mobilization cost was 33,319 yuan and46,589 yuan, respectively. After the first mobilization failed, 61.5% of the patients chose the second mobilization. The average mobilization time before stem cell collection by G-CSF and CM+G-CSF mobilization programs was 5.67 and 6.54 days respectively.And the acquisition time was 5.91 and 4.98 days respectively. The mobilization success rate was 46.50% and 50.00%, and the total mobilization cost was 39,897 yuan and 41,686 yuan, respectively. After the first mobilization failed, 38.5% of patients chose allogeneic peripheral blood stem cell transplantation, allogeneic bone hematopoietic stem cell transplantation, and salvage therapies.The average cost were 244 000.00±19,089.82 yuan, 178 975.00±19 768.41 yuan and 79 400.00±15 449.14 yuan, respectively.Conclusion At present, the success rates of stem cell mobilization therapies including G-CSF and CM+G-CSF for patients with NHL are low, which will increase the disease economic burden and medical resource utilization. The more effective stem cell mobilization strategy is urgently needed.
引文
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[6]Mohty M,Hübel K,Kr?ger N,et al.Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients:a position statement from the European Group for Blood and Marrow Transplantation[J].Bone Marrow Transplant,2014,49(7):865-872.
[7]Duong HK,Savani BN,Copelan E,et al.Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation:guidelines from the American Society for Blood and Marrow Transplantation[J].Biol Blood Marrow Transplant,2014,20(9):1262-1273.
[8]Karst A,Lister J.Utilization of G-CSF and GM-CSF as an alternative to discontinuation in clozapine-induced neutropenia or leukopenia:A case report and discussion[J].Ment Health Clin,2018,8(5):250-255.
[9]Zhu J,Huang H,Chen H,et al.Plerixafor and granulocytecolony-stimulating factor for mobilization of hematopoietic stem cells for autologous transplantation in Chinese patients with non-Hodgkin's lymphoma:a randomized Phase 3 study[J].Transfusion,2017,58(1):81-87.
[10]Issaragrisil S,Cheng-Hwai T,Bunworasate U,et al.Cyclophosphamide vs salvage chemotherapy plus G-CSF as chemomobilization in Asianpatients undergoing autologous hematopoietic stem cell transplant[J].Bone Marrow Transplant,2017,52(2):299-300.
[2]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics2018:GLOBOCAN estimates of incidence and mortality worldwidefor 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[3]Han X,Ma L,Zhao L,et al.Predictive factors for inadequate stem cell mobilization in Chinese patients with NHL and HL:14-year experience of a single-center study[J].J Clin Apher,2012,27(2):64-74.
[4]刘海川,姚善谦,楼方定,等.自体外周血造血干细胞移植治疗白血病及淋巴瘤的临床研究[J].中华血液学杂志,1996,17(10):548-549.
[5]Philip T,Guglielmi C,Hagenbeek A,et al.Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma[J].NEngl J Med,1995,333(23):1540-1545.
[6]Mohty M,Hübel K,Kr?ger N,et al.Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients:a position statement from the European Group for Blood and Marrow Transplantation[J].Bone Marrow Transplant,2014,49(7):865-872.
[7]Duong HK,Savani BN,Copelan E,et al.Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation:guidelines from the American Society for Blood and Marrow Transplantation[J].Biol Blood Marrow Transplant,2014,20(9):1262-1273.
[8]Karst A,Lister J.Utilization of G-CSF and GM-CSF as an alternative to discontinuation in clozapine-induced neutropenia or leukopenia:A case report and discussion[J].Ment Health Clin,2018,8(5):250-255.
[9]Zhu J,Huang H,Chen H,et al.Plerixafor and granulocytecolony-stimulating factor for mobilization of hematopoietic stem cells for autologous transplantation in Chinese patients with non-Hodgkin's lymphoma:a randomized Phase 3 study[J].Transfusion,2017,58(1):81-87.
[10]Issaragrisil S,Cheng-Hwai T,Bunworasate U,et al.Cyclophosphamide vs salvage chemotherapy plus G-CSF as chemomobilization in Asianpatients undergoing autologous hematopoietic stem cell transplant[J].Bone Marrow Transplant,2017,52(2):299-300.