Abstract
BackgroundFor successful autologous stem cell transplantation, the collection of a sufficient number of hematopoietic stem cells after induction therapy is essential for transplant candidates with multiple myeloma (MM).MethodsIn this study, we compared the efficacy and safety of stem cell mobilization using cyclophosphamide (CY; 3.0 g/m2 on day 1) or etoposide (VP-16; 375 mg/m2 on days 1 and 2) in patients with MM. Granulocyte-colony stimulating factor (G-CSF, 10 μg/kg/day, subcutaneously) was administered from the onset of neutropenia to the final day of collection.ResultsSixty-five patients were mobilized with a combination of CY and G-CSF, and 63 were mobilized with a combination of VP-16 and G-CSF. All patients were mobilized within 7 months of beginning frontline treatment. The median number of CD34+ cells collected was significantly higher in the VP-16 mobilization group than in the CY mobilization group (27.6 × 106 CD34+/kg vs. 9.6 × 106 CD34+/kg, P < 0.001). The rate of mobilization failure, defined as < 2.0 × 106 CD34+/kg collected in three apheresis procedures, was lower in the VP-16 group than in the CY group (1.6% vs. 10.8%, P = 0.062). Severe infections during the mobilization period were more frequent in the CY group than in the VP-16 group (18.5% vs. 7.9%, P = 0.117).ConclusionIn conclusion, an intermediate dose of VP-16 with G-CSF appears to be an effective and tolerable chemo-mobilization method compared to CY and G-CSF, particularly in cases where use plerixafor in MM is difficult.
Highlights
For successful autologous stem cell transplantation, the collection of a sufficient number of hematopoietic stem cells after induction therapy is essential for transplant candidates with multiple myeloma (MM)
The frontline treatment differed slightly between the two groups, with more patients being treated with a bortezomib-containing regimen in the VP-16 group (65.1% vs. 23.1%, P < 0.001)
Despite differences in frontline treatment, disease responses to the initial regimen
Summary
For successful autologous stem cell transplantation, the collection of a sufficient number of hematopoietic stem cells after induction therapy is essential for transplant candidates with multiple myeloma (MM). With the emergence of new and more effective therapeutic agents, the role of autologous stem cell transplantation (ASCT) in multiple myeloma (MM) has become a topic of considerable interest. There have been only a few studies evaluating the efficacy of ASCT with novel agent-based therapies, upfront ASCT did show a better response and a longer progression free survival (PFS) in a randomized phase 3 EMN02/HO95 trial (HR = 0.76; 95% confidence interval [CI] = 0.64–0.91; P = 0.002). As obtaining a sufficient dose of stem cells is important to achieve stem cell engraftment, numerous strategies have been developed to expand the pool of circulating hematopoietic stem cells [6]. Chemo-mobilization achieves higher yields of stem cells
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