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Objective:To explore the safety and efficacy of EAC [etoposide+ cytarabine+ cyclophosphamide (CTX)] mobilization scheme for mobilizing stem cells in patients with lymphoma undergoing autologous hematopoietic stem cell transplantation (ASCT).Methods:A total of 36 patients with lymphoma who had collected peripheral blood stem cells through EAC or CTX+ granulocyte colony stimulating factor (G-CSF) mobilization scheme in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2018 to March 2020 were retrospectively analyzed. Among them, 16 patients used EAC mobilization (EAC group), and 20 patients used CTX (CTX group). When white blood cells≤1.0×10 9/L, G-CSF (10 μg/kg per day) was given subcutaneously in two doses. The changes of hematology indexes, the number of collected cells, adverse reactions during mobilization collection and hematopoietic reconstitution after ASCT were observed. Results:The peripheral blood stem cells were collected on 5 d (3-8 d) after EAC+ G-CSF mobilization and 7 d (4-12 d) after CTX+ G-CSF mobilization. The success rates of collection in the EAC group and CTX group were 100% (16/16) and 75.0% (15/20) respectively, the high-quality collection rates were 87.5% (14/16) and 25.0% (5/20) respectively, and there were statistically significant differences ( P=0.041; P<0.001). The median of CD34 + cells of the two groups was 13.67×10 6/kg and 3.45×10 6/kg respectively, the median of mononuclear cells was 7.16×10 8/kg and 5.09×10 8/kg respectively, the median of CD34 + cells/mononuclear cells was 1.44% and 0.67% respectively, and there were statistically significant differences ( Z=-4.219, P<0.001; Z=-2.118, P=0.034; Z=-3.104, P=0.002). In the EAC group and CTX group, the incidences of grade 3 and above granulocytopenia were 100% (16/16) and 90.0% (18/20) respectively, the incidences of grade 3 and above hemoglobin reduction were 43.8% (7/16) and 25.0% (5/20) respectively, the incidences of grade 3 and above thrombocytopenia were 87.5% (14/16) and 65.0% (13/20) respectively, and there were no statistically significant differences ( P=0.492; P=0.298; P=0.245). There were no significant differences in the incidences of infection, adverse reactions of digestive system or other adverse reactions between the two groups (all P>0.05). All patients accepted improved Bucy scheme before ASCT. The median implantation time of neutrophils and platelets was 9.0 d and 10.5 d in the EAC group, which was 12.0 d and 13.5 d in the CTX group, and there were statistically significant differences ( Z=-4.698, P<0.001; Z=-3.757, P<0.001). Conclusion:EAC mobilization scheme can significantly increase the number of hematopoietic stem cell. This scheme has a high success rate of high-quality collection and the adverse reactions are within the controllable range. It provides a high-quality mobilization scheme for hematopoietic stem cell mobilization and collection, which is worthy of clinical promotion and application.
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Objective To compare the clinical efficacy of empirical therapy and diagnostic-driven the-rapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). Methods The clinical data of patients with hematological malignancies undergoing antifungal treat-ment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital,Chinese Aca-demy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria,of which,28 received the empirical therapy and 40 received the diagnostic-driven therapy. Then the differences of the incidence of IFD,IFD-related mor-tality,days of hospitalization and antifungal treatment between the two groups were compared. Results The incidence of IFD in the diagnostic-driven therapy group was higher than that in the empirical therapy group [27. 5％ (11 / 40)vs. 7. 1％ (2 / 28),χ2 = 4. 414,P = 0. 036]. While the rates of IFD-related mortality were 7. 5％ (3 / 40)and 3. 6％ (1 / 28)respectively,with no statistically significant difference (χ2 = 0. 459,P =0. 498). The number of antifungal treatment days in the diagnostic-driven therapy group was greater than that in the empirical therapy group [(15. 9 ± 3. 3)d vs. (13. 1 ± 2. 5)d,t = - 3. 654,P = 0. 001]. While the num-bers of hospitalization days were similar in the two groups [(20. 1 ± 2. 1)d vs. (19. 4 ± 2. 3)d],with no sta-tistically significant difference (t = - 1. 273,P = 0. 208). Conclusion Both diagnostic-driven therapy and empirical therapy are helpful to early antifungal treatment,and they should be performed properly combined with the actual clinical conditions.
