Efficacy of vinorelbine plus G-CSF for CD34+ hematopoietic progenitor cell mobilization in patients with multiple myeloma

Abstract

We aimed to assess the efficacy of vinorelbine plus G-CSF for chemo-mobilization of CD34+ hematopoietic progenitor cells (HPC) in patients with multiple myeloma and to identify adverse risk factors for successful mobilization. Vinorelbine 35 mg/m(2) was administered intravenously on day 1 in an outpatient setting. Filgrastim 5 μg per kg body weight (BW) was given twice daily subcutaneously from day 4 on until the end of the collection procedure. Leukapheresis was scheduled to start on day 8 and performed for a maximum of three consecutive days until at least 4x10(6) CD34+ cells per kg BW were collected. Overall, 223 patients were mobilized and 221 (99%) patients proceeded to leukapheresis. Three (1.5%) patients required an unscheduled hospitalization after chemo-mobilization due to neutropenic fever and renal failure (n=1), severe bone pain (n=1), and abdominal pain with constipation (n=1). In 211 (95%) patients the leukaphereses were started as planned at day 8, while in 8 (3%) patients the procedure had to be postponed to day 9 and in two (1%) patients to day 10. In the great majority of patients (77%) the predefined amount of HPC could be collected with one leukapheresis. Fourty-four (20%) patients needed a second leukapheresis, while only 6 (3%) patients required a third leukapheresis procedure. The median number of CD34+ cells collected was 6.56x10(6) (range, 0.18-25.9x10(6)) per kg BW at the first day of leukapheresis and 7.65x10(6) (range, 0.18-25.9x10(6)) per kg BW in total. HPC collection was successful in 212 (95%) patients after a maximum of three leukaphereses. Patient age (p=0.02) and prior exposition to lenalidomide (p<0.001) were independent risk factors for a lower HPC amount collected in multiple regression analysis. Vinorelbine plus G-CSF enables a very reliable prediction of the timing of leukapheresis and results in successful HPC collection in 95% of the patients.