Cyclophosphamıde–Etoposıde + G-csf Compared to G-csf alone in Perıpheral Blood Stem Cell Mobılızatıon for Multıple Myeloma

Abstract

Background: Multiple myeloma (MM) is the leading indication of autologous hematopoietic stem cell transplantation (AHSCT). There are different regimens used for peripheral blood stem cell mobilization in MM. A minimum of 2 × 106 CD34 + cells/kg are needed for engraftment. This study that present a comparison of the mobilization outcomes Cyclophosphamide-Etoposide (Cy-Et) + granulocyte-colony stimulating factor (G-CSF) group and G-CSF alone group. Patients and methods: This study has been performed in a retrospective manner. 110 patients with diagnosed MM who underwent stem cell mobilization at Memorial Sisli Hospital between the years of 2013 and 2018 were evaluated. We retrieved data on patient demographics, disease status at mobilization, treatment characteristics, stem cell mobilization, collection and post AHSCT outcomes. For mobilization, 70 patients received cyclophosphamide 1250 mg/m2 for 2 day, etoposide 100 mg/m2 for 3 day and G-CSF 10 mcg/kg/day from day 4 onwards and 40 patients received G-CSF alone. Results: In 98 of 110 patients (89.1%) first mobilization trial was successful. Four patients in the Cy-Et group (5,7%) and eight patients in the G-CSF alone group (20%) were mobilized three times (p=0.001). The number of CD34 in peripheral blood was significantly higher in Cy-Et group (94±14) than G-CSF alone group (54±7) (p=0.04) on the stem cell mobilization time. Stem cell collection was higher in the Cy-Et group (13.8 × 106 CD34 + cells/kg) compared to the G-CSF alone group (8.8× 106 CD34 + cells/kg) (p =0.001). The median time to neutrophil engraftment was 11 and 13 days in Cy-Et group and G-CSF alone group respectively (p=0.014). The median time to platelet engraftment was 15 and 17 days in Cy-Et group and G-CSF alone group respectively (p=0.006). Median 360 ml stem cells in Cy-Et group and 470 ml stem cells in G-CSF alone group were collected and this difference was statistically significant (P=0.001). Conclusion: In conclusion, this study was demonstrated that Cy-Et + G-CSF mobilization provides a higher peripheral CD 34 count, less apheresis sessions, less volume, more stem cell mobilization, earlier neutrophils and platelet engraftment for patients with MM and eligible for AHSCT. Today, Cy-Et + G-CSF mobilization is a really useful method than G-CSF alone.