Zhongguo shi yan xue ye xue za zhi · 2026
[Clinical Study and Economic Evaluation of High-Dose Etoposide Combined with Mecapegfilgrastim for Autologous Peripheral Blood Stem Cell Mobilization in Patients with Lymphoma].
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Zhang Wen-Jie, Feng You-Fan, Wei Xiao-Fang, Nie Lu, Zhao Yang-Yang, Zhang Qi-Ke
Аннотация
OBJECTIVE: To investigate the efficacy, safety and cost-effectiveness of single high-dose etoposide (VP-16) combined with mecapegfilgrastim for mobilizing autologous peripheral blood stem cells (APBSC) in patients with lymphoma.
METHODS: This study included 42 lymphoma patients from Gansu Provincial Hospital (January 2019 to December 2023), of whom 32 received VP-16 combined with mecapegfilgrastim for stem cell mobilization and collection, while 10 received plerixafor combined with mecapegfilgrastim for stem cell mobilization during the same period. Their clinical data were collected, including age, sex, pathological type, chemotherapy cycles, Eastern Cooperative Oncology Group (ECOG) performance status score, body mass index (BMI), lactate dehydrogenase (LDH) level, adverse events, neutrophil and platelet engraftment times after transplantation, and total mobilization cost, etc. The efficacy, safety and cost-effectiveness between the two mobilization regimens (high-dose VP-16+mecapegfilgrastim vs. plerixafor+mecapegfilgrastim) were compared, and the related influencing factors of mobilization efficacy were analyzed.
RESULTS: A total of 76 mobilization procedures were performed in 42 patients. In the VP-16+mecapegfilgrastim group, the median number of collected CD34+ cells was 4.89×106/kg, with a collection success rate of 90.62% and an excellent rate of 31.25%. In the plerixafor+mecapegfilgrastim group, the median number of collected CD34+ cells was 5.22×106/kg, with a success rate of 100% and an excellent rate of 50%. There were no significant differences in these indices between the two groups (P >0.05), but the collection days in the former group were significantly more than those in the latter group (P <0.05). The VP-16+mecapegfilgrastim group had significantly higher rates of hematological toxicity, platelet transfusion, infection, and grade 1-2 gastrointestinal reactions than the plerixafor+mecapegfilgrastim group (P <0.05), but there were no significant differences in the incidence of grade 3-4 gastrointestinal reactions, allergy, or bone pain between the two groups (P >0.05). There were also no significant differences in the neutrophil and platelet engraftment times after transplantation between the two groups (P >0.05). Multivariate analysis showed that the number of prior chemotherapy cycles≥4, lenalidomide exposure, and LDH≤450 U/L on the day of collection were independent risk factors affecting stem cell collection (P <0.05). The total mobilization cost per capita in the VP-16+mecapegfilgrastim group was 21 931.98 yuan, and that in the plerixafor+mecapegfilgrastim group was 65 822.47 yuan. The cost-effectiveness ratios (CER) for the two groups were 701.82 and 1 316.45, respectively, and the incremental cost-effectiveness ratio (ICER) was 2 340.83.
CONCLUSION: Mobilizing peripheral blood stem cells in lymphoma patients with a single high-dose of etoposide combined with mecapegfilgrastim is effective, safe and cost-effective.
METHODS: This study included 42 lymphoma patients from Gansu Provincial Hospital (January 2019 to December 2023), of whom 32 received VP-16 combined with mecapegfilgrastim for stem cell mobilization and collection, while 10 received plerixafor combined with mecapegfilgrastim for stem cell mobilization during the same period. Their clinical data were collected, including age, sex, pathological type, chemotherapy cycles, Eastern Cooperative Oncology Group (ECOG) performance status score, body mass index (BMI), lactate dehydrogenase (LDH) level, adverse events, neutrophil and platelet engraftment times after transplantation, and total mobilization cost, etc. The efficacy, safety and cost-effectiveness between the two mobilization regimens (high-dose VP-16+mecapegfilgrastim vs. plerixafor+mecapegfilgrastim) were compared, and the related influencing factors of mobilization efficacy were analyzed.
RESULTS: A total of 76 mobilization procedures were performed in 42 patients. In the VP-16+mecapegfilgrastim group, the median number of collected CD34+ cells was 4.89×106/kg, with a collection success rate of 90.62% and an excellent rate of 31.25%. In the plerixafor+mecapegfilgrastim group, the median number of collected CD34+ cells was 5.22×106/kg, with a success rate of 100% and an excellent rate of 50%. There were no significant differences in these indices between the two groups (P >0.05), but the collection days in the former group were significantly more than those in the latter group (P <0.05). The VP-16+mecapegfilgrastim group had significantly higher rates of hematological toxicity, platelet transfusion, infection, and grade 1-2 gastrointestinal reactions than the plerixafor+mecapegfilgrastim group (P <0.05), but there were no significant differences in the incidence of grade 3-4 gastrointestinal reactions, allergy, or bone pain between the two groups (P >0.05). There were also no significant differences in the neutrophil and platelet engraftment times after transplantation between the two groups (P >0.05). Multivariate analysis showed that the number of prior chemotherapy cycles≥4, lenalidomide exposure, and LDH≤450 U/L on the day of collection were independent risk factors affecting stem cell collection (P <0.05). The total mobilization cost per capita in the VP-16+mecapegfilgrastim group was 21 931.98 yuan, and that in the plerixafor+mecapegfilgrastim group was 65 822.47 yuan. The cost-effectiveness ratios (CER) for the two groups were 701.82 and 1 316.45, respectively, and the incremental cost-effectiveness ratio (ICER) was 2 340.83.
CONCLUSION: Mobilizing peripheral blood stem cells in lymphoma patients with a single high-dose of etoposide combined with mecapegfilgrastim is effective, safe and cost-effective.