G-CSF + plerixafor versus G-CSF alone mobilized hematopoietic stem cells in patients with multiple myeloma and lymphoma: a systematic review and meta-analysis

The combination of granulocyte-colony stimulating factor (G-CSF) and plerixafor is one of the approaches for hematopoietic stem cell mobilization in patients with multiple myeloma (MM), non-Hodgkin’s lymphoma (NHL), and Hodgkin’s lymphoma (HL). This systematic review and meta-analysis aimed to determine the ability of G-CSF + plerixafor to mobilize peripheral blood (PB) CD34+ cells and examine its safety profile. We performed a database search using the terms ‘granulocyte colony stimulating factor’, ‘G-CSF’, ‘AMD3100’, and ‘plerixafor’, published up to May 1, 2023. The methodology is described in further detail in the PROSPERO database (CRD42023425760). Twenty-three studies were included in this systematic review and meta-analysis. G-CSF + plerixafor resulted in more patients achieving the predetermined apheresis yield of CD34+ cells than G-CSF alone (OR, 5.33; 95%, 4.34–6.55). It was further discovered that G-CSF + plerixafor could mobilize more CD34+ cells into PB, which was beneficial for the next transplantation in both randomized controlled (MD, 18.30; 95%, 8.74–27.85) and single-arm (MD, 20.67; 95%, 14.34–27.00) trials. Furthermore, G-CSF + plerixafor did not cause more treatment emergent adverse events than G-CSF alone (OR, 1.25; 95%, 0.87–1.80). This study suggests that the combination of G-CSF and plerixafor, resulted in more patients with MM, NHL, and HL, achieving the predetermined apheresis yield of CD34+ cells, which is related to the more effective mobilization of CD34+ cells into PB.

粒细胞集落刺激因子（granulocyte-colony stimulating factor, G-CSF）与普乐沙福（plerixafor）联合方案，是多发性骨髓瘤（multiple myeloma, MM）、非霍奇金淋巴瘤（non-Hodgkin’s lymphoma, NHL）及霍奇金淋巴瘤（Hodgkin’s lymphoma, HL）患者造血干细胞动员（hematopoietic stem cell mobilization）的常用手段之一。本项系统评价与荟萃分析旨在探究G-CSF联合普乐沙福动员外周血（peripheral blood, PB）CD34+细胞的效果，并评估其安全性。本研究以“粒细胞集落刺激因子”“G-CSF”“AMD3100”及“普乐沙福”为检索词，检索了截至2023年5月1日的相关文献。本研究的详细方法学信息已收录于PROSPERO注册数据库（CRD42023425760）。本项系统评价与荟萃分析共纳入23项研究。相较于单用G-CSF方案，G-CSF联合普乐沙福可使更多患者达到预设的CD34+细胞单采采集阈值（比值比[odds ratio, OR]=5.33，95%置信区间[CI]=4.34~6.55）。进一步分析显示，G-CSF联合普乐沙福可动员更多CD34+细胞进入外周血，这对后续移植治疗有益：在随机对照试验中（均数差[mean difference, MD]=18.30，95%CI=8.74~27.85）及单臂试验中（MD=20.67，95%CI=14.34~27.00）均得到了一致结果。此外，相较于单用G-CSF，G-CSF联合普乐沙福并未增加治疗期间不良事件的发生风险（OR=1.25，95%CI=0.87~1.80）。本研究表明，针对MM、NHL及HL患者，G-CSF联合普乐沙福方案可使更多患者达到预设的CD34+细胞单采采集阈值，这与该方案能更有效地动员CD34+细胞进入外周血密切相关。