Improved progression-free and event-free survival in myeloma patients undergoing PBSCH receiving a cyclophosphamide+G-CSF regimen than G-CSF alone.

Abstract

Two regimens are commonly used for peripheral blood hematopoietic stem cell harvesting (PBSCH) in multiple myeloma: high-dose cyclophosphamide (HD-CY)+granulocyte-colony stimulating factor (G-CSF), and G-CSF alone. The objective of the present study was to evaluate the anti-myeloma effect of the PBSCH regimen including HD-CY. We retrospectively assessed harvesting efficiency, complications, and anti-myeloma effects in 115 patients receiving HD-CY+G-CSF (HD-CY group) and 32 patients receiving G-CSF alone (G-alone group). We collected>2×106 CD34-positive cells/kg from 93 and 75% of patients in the HD-CY and G-alone groups, respectively (P=0.0079). The mean HSC count was also higher in the HD-CY group. No severe complications were observed in the G-alone group, whereas 66% of patients in the HD-CY group were treated with intravenous antibiotics. The median progression-free and event-free survival (PFS and EFS) were longer in the HD-CY group than in the G-alone group (28 vs. 18months and 25 vs. 13months, respectively; P=0.0127 and 0.0139), with no difference in median overall survival. HD-CY showed anti-myeloma effect, as verified by prolonged EFS and PFS, when a vincristine, doxorubicin, and dexamethasone regimen was administered as induction before PBSCH.