Abstract
BackgroundEfficient mobilization of CD34+ hematopoietic stem cells plays a vital role in successful autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM), especially in cases with high-risk cytogenetic recommended for tandem ASCT. However, the optimal mobilization strategy remains a matter of debate in the era of lenalidomide. The combination of etoposide with Cytarabine plus G-CSF as a novel mobilization regimen in MM has not been reported previously.MethodsThis research retrospectively studied mobilization efficacy and safety using etoposide combined with Cytarabine (etoposide 50–100 mg/m2, qd d1–3; AraC 0.5 g/m2, q12h d1~3) plus G-CSF (5 µg/kg/day, from d5 until the day of apheresis) in 128 patients with MM. 70(54.7%) patients received lenalidomide-based induction regimens treatmentResultsA median of 27.75×106 CD34+ cells/kg was collected in the first apheresis, and 28.23×106 CD34+ cells/kg were collected overall. Of the 128 patients, all achieved adequate collection (≥2×106 CD34+ cells/kg), 121(94.5%) achieved optimal collection for single ASCT (≥5×106 CD34+ cells/kg), and 114(89.1%) harvested optimal collection for tandem ASCT (≥10×106 CD34+ cells/kg). In particular, the target yield of optimal collection for tandem ASCT was reached in 82.8% (106/128) by a single apheresis procedure. 14 patients obtained deeper response post mobilization. In multivariate analysis, cycles of prior chemotherapy independently affected the optimal achievement of CD34+ cells (p=0.004, OR 0.695, 95% CI 0.544~0.888). Previous lenalidomide exposure did not significantly impair CD34+ cells collection. Although 68% episodes of antibiotic usage were observed, no severe infection or treatment-related mortality occurred.ConclusionStem cell mobilization with Etoposide + Cytarabine plus G-CSF was highly efficient and safe in patients with MM, which could be considered in high-risk MM patients who were referred for tandem ASCT.
Highlights
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is an important option for transplanteligible patients with multiple myeloma (MM) [1, 2], which can significantly improve patients’ outcomes
The use of Cy during chemo-mobilization has been linked to increased morbidity such as febrile neutropenia [9], and plerixafor administration is associated with high cost, which has led to its restricted use as a pre-emptive regimen for patients at high risk for mobilization failure [10, 11]
The optimal regimen for the cost-efficient collection of hematopoietic stem cells (HSCs) remains a challenge, in patients with MM who were referred for tandem ASCT
Summary
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is an important option for transplanteligible patients with multiple myeloma (MM) [1, 2], which can significantly improve patients’ outcomes. Adequate collection of CD34+ hematopoietic stem cells (HSCs) is important for successful engraftment post-ASCT, and high collection is associated with faster hematologic recovery, reduced infection risk, and improved overall survival [4, 5]. The optimal regimen for the cost-efficient collection of HSCs remains a challenge, in patients with MM who were referred for tandem ASCT. Efficient mobilization of CD34+ hematopoietic stem cells plays a vital role in successful autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM), especially in cases with high-risk cytogenetic recommended for tandem ASCT. The combination of etoposide with Cytarabine plus G-CSF as a novel mobilization regimen in MM has not been reported previously
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