Influence Factors Of Hematopoietic Stem Cell Mobilization In Patients With Multiple Myeloma And Lymphoma

Background: High-dose chemotherapy combined with autologous hematopoietic stem cell transplantation(HSCT)plays an important role in the overall treatment of multiple myeloma and lymphoma,and is an essential treatment that has greatly improved the remission rate and long-term survival of patients.Mobilization collection of stem cells is a necessary step in the transplantation process.Current studies have shown that mobilization failure rate is relatively high,which not only affects the prognosis of patients,but also increases the cost of medical care for patients.Exploring risk factors affecting hematopoietic stem cell collection and accurately identifying patients with high risk factors are conducive to improving the success rate of peripheral blood hematopoietic stem cell collection and achieving low-risk transplantation.Objective: To explore the related high risk factors of peripheral blood hematopoietic stem cell mobilization and collection in patients with multiple myeloma(MM)and lymphoma,and to analyze the influence of the number of collected hematopoietic stem cells on the time of neutrophils and platelets implantation after transplantation,accurately identify patients with high risk factors,timely adjust the treatment plan and guide clinical medication.Methods: Data of hematopoietic stem cell mobilization,collection and transplantation in peripheral blood of 42 MM patients and 50 lymphoma patients from January 2015-December 2020 were retrospectively analyzed.To analyze gender,age,relapses,bone marrow involvement,radiotherapy,G-CSF days of use,pre-mobilization chemotherapy regimen,pre-mobilization chemotherapy duration and specific targeted drugs on the results of the first collection of hematopoietic stem cells.The relationship between hematopoietic stem cell infusion and hematopoietic implantation was studied.The results of hematopoietic stem cell mobilization were represented by CD34~+ cell count.Statistical analyses were performed using SPSS26.0 statistical software.Result: In MM patients,the number of CD34~+ cells collected in the RVD group was significantly lower than that in the BCD group(P =0.013),and the success rate of the first collection was lower,suggesting that the application of linalidomide affected the collection of hematopoietic stem cells.The difference were statistically significant(P=0.049).The number of CD34~+ cells collected in patients younger than 60 years was higher than that in patients older than 60 years(P=0.040).Patients with fewer than 6chemotherapy courses before mobilization had better collection effect,and CD34~+ cell count was higher than patients with 6 times of chemotherapy,and the result was statistically significant(P=0.038).Patients in the BCD group received more hematopoietic stem cells,and neutrophils(P < 0.001)and platelets(P < 0.001)Implantation is faster.In lymphoma patients,the number of chemotherapy courses was negatively correlated with the collected CD34~+ cell count(P=0.031).Hematopoietic stem cell collection was poor in patients with relapse before transplantation,and the results were statistically significant(P=0.014).Among the radiotherapy patients,mobilization failure was relatively high,with a failure rate of 88.89%.Radiotherapy had a negative effect on hematopoietic stem cell collection(P=0.006).The higher the CD34~+ cell count,the faster the neutrophils implantation,and the results were statistically significant,while the effect on post-transplant platelet implantation was not so significant.There was no significant difference in CD34~+ cell count between the G-CSF use days < 5d and ≥5d before collection.Conclusion: In MM patients,chemotherapy regimens containing lenalidomide will damage hematopoietic stem cells and increase the difficulty of hematopoietic stem cell collection.Especially for older patients,chemotherapy regimens containing lenalidomide before mobilization should be carefully selected.At the same time,the number of chemotherapy courses before mobilization should be moderate,too much chemotherapy will damage hematopoietic stem cells,according to the patient’s condition and the actual situation can be put the last chemotherapy after the collection.In lymphoma patients,prior relapse and radiation therapy can significantly impair hematopoietic stem cells.To continuously explore the risk factors that may affect hematopoietic stem cell mobilization collection and improve the peripheral blood hematopoietic stem cell mobilization program.Predict patients with high risk of failure in advance,avoid negative factors of hematopoietic stem cell collection as far as possible,and reduce the failure rate of collection.