Abstract
BackgroundHigh-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. However, the collection of sufficient peripheral blood stem cell (PBSC) grafts can be challenging, and the question arises whether reinfusion of low-dose grafts will lead to a hematopoietic recovery.MethodsThe hematopoietic recovery of 148 MM patients who underwent HD melphalan chemotherapy and received PBSC transplants with varying CD34+ cells doses (3–4 × 106 [n = 86], 2–2.5 × 106 [n = 53], < 2 × 106 [n = 9] per kg body weight [bw]) was analyzed in this retrospective single-center study.ResultsAll patients reached hematopoietic reconstitution, even those who received < 2 × 106 CD34+ cells/kg bw. 62 (42%) patients received granulocyte-colony-stimulating factor (G-CSF). The median duration to leukocyte recovery ≥1.0 × 109/L was 12 days in every group. The median duration to platelet recovery ≥20 × 109/L was 11, 13 and 13 days, respectively. In the multivariate analysis, a low number of reinfused CD34+ cells was associated with prolonged time until leukocyte reconstitution (p = 0.010, HR 0.607) and platelet recovery (p < 0.001, HR 0.438). G-CSF support significantly accelerated leukocyte (p < 0.001, HR 16.742) but not platelet reconstitution.ConclusionIn conclusion, reinfusion of low- and even very-low-dose PBSC grafts leads to sufficient hematopoietic reconstitution. No severe adverse events were observed during or after HD chemotherapy and ASCT in the analyzed cohort. While the impact of CD34+ cell dose is marginal, G-CSF significantly accelerates the leukocyte recovery.
Highlights
High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients
Later studies showed that salvage HD/ASCT may represent an effective treatment option for MM patients who relapse after a sustained remission that lasted longer than 1 year after a prior ASCT [7,8,9]
This issue is of great relevance, to MM patients who might significantly benefit from HD/ ASCT treatment in terms of MM disease control
Summary
High-dose (HD) chemotherapy followed by autologous blood stem-cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM) patients. Many factors, such as higher age, previous extensive chemotherapy, and treatment with melphalan or radiation therapy, might be associated with poor PBSC mobilization, despite the use of plerixafor, which results in borderline sufficient (< 2.0–2.5 × 106 CD34+ cells/kg bw) grafts [15,16,17,18,19] In this case, transplant centers frequently face the question of whether reinfusion of grafts with marginal PBSC numbers will lead to a delay in hematopoietic recovery after HD chemotherapy and subsequently cause any complications or even severe adverse events due to prolonged neutropenia. This issue is of great relevance, to MM patients who might significantly benefit from HD/ ASCT treatment in terms of MM disease control
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