108-2 醫學(二) 第72題
臨床上使用G-CSF治療多發性骨髓瘤(multiple myeloma)過程中,可併服造血性幹細胞穩定藥物plerixafor,以達較佳療效。試問此穩定藥物之作用機制為何?
  • 強化JAK/STAT訊息活化
  • 促進G-CSF釋出
  • 抑制CXC chemokine receptor 4(CXCR4)
  • 提高G-CSF與接受體之結合效益

本題詳解

plerixafor 為hematopoietic stem cell mobilizer,與顆粒球群落形成刺激因子(G-CSF)並用,刺激造血幹細胞由骨髓釋放到周邊,供收集以施行自體移植。適用於要做自體移植的non-Hodgskin's lymphoma或是multiple myeloma的病患。


Plerixafor 

- Prevents the binding of stromal cell-derived factor-1α (SDF-1α) to the CXCR4 chemokine receptor. 

- Disrupts interaction between SDF-1α and its receptor and interferes with retention of hematopoietic stem cells in bone marrow matrix. 

-> Subsequently, increased numbers of CD34+ hematopoietic progenitor cells are mobilized or released from bone marrow, resulting in peripheral leukocytosis. 

=> Mobilized CD34+ cells were then collected by apheresis and used as a stem-cell infusion to promote engraftment following high-dose chemotherapy associated with autologous stem-cell transplantation

造血幹細胞驅動劑 plerixafor ( Mozobil®,總動原注射劑 ),是一澄清無色至淡 黃色注射液,可抑制造血幹細胞或腫瘤細胞之 CXC chemokine receptor 4 ( CXCR4 ),阻斷 CXCR4 與骨髓 內骨基質細胞之 stromal cell-derived factor-1-alpha ( SDF-1α ) 連結,使白血球細胞增生及周邊血造血 先驅細胞增加。所以 plerixafor 搭配 G-CSF 可協同 驅動出足夠帶有 CD34+抗原的造血幹細胞,以供移 植之用。由於被驅動的造血幹細胞表面有 CD34+ 抗原,可用此標誌定量及計數造血幹細胞,也可降 低微量癌細胞污染可能性。