Peripheral Blood Progenitor Cells Mobilization in Patients with Multiple Myeloma

Roberto Ria Angelo Vacca

doi:10.4172/2157-7633.1000226

Abstract

Autologous stem cell transplantation (ASCT) is considered the standard therapy for younger patients with newly diagnosed symptomatic multiple myeloma (MM). The introduction into clinical practice of novel agents (i.e.: proteasome inhibitors and immunomodulatory derivatives [IMiDs]) has significantly contributed to major advances in MM therapy and prognosis. These novel agents are incorporated into induction regimens to enhance the depth of response before ASCT and further improve post-ASCT outcomes. Collection of adequate hematopoietic stem cells (HSCs) is necessary for successful autologous transplantation. The mobilizing regimen usually consists of cyclophosphamide or disease-specific agents, in combination with a hematopoietic cytokine, usually G-CSF, which mobilizes HPSCs into the bloodstream, in particular when administered after myelosuppressive chemotherapy. In some patients, the number of mobilized CD34+ cells is not sufficient to perform successful stem cell transplantation due to bone marrow damage by neoplastic proliferation and/or chemoradiotherapy. To improve the collection of CD34+ cells, the mobilization procedure can be repeated or an alternative chemotherapy regimen can be chosen. Recently, the new drug plerixafor (Mozobil®) has been introduced to increase the number of circulating CD34+ cells. Its use increases the level of functional HPCs in the peripheral blood, with long-term resettlement

Highlights

High-dose chemotherapy, supported by autologous hematopoietic stem cell transplantation (ASCT), is an effective treatment strategy for a variety of hematologic malignancies [1,2,3,4]
The collection of adequate numbers of hematopoietic stem cells (HSCs) is a prerequisite for proceeding to autologous transplantation; approximately 5% to 40% of patients do not meet the minimum threshold of 2×106 CD34+ cells/kg that is associated with timely engraftment [5,6,7,8,9]
Our results show that cyclophosphamide in association with lenograstim results in more adequate mobilization, and the HSC collection target is reached more quickly and requires fewer leukaphereses in patients with MM, non-Hodgkin lymphoma (NHL) or HL that are typical candidates for ASCT and for combined mobilization with chemotherapy and granulocyte-colony stimulating factor (G-CSF)

Summary

Introduction

High-dose chemotherapy, supported by autologous hematopoietic stem cell transplantation (ASCT), is an effective treatment strategy for a variety of hematologic malignancies [1,2,3,4]. Priming with lenograstim at 25% lower dose does not negatively affect the number of CD34 stem cells harvested, or engraftment results and may achieve an economic benefit in regard to G-CSF requirement or number of vials needed for a successful mobilization and ASCT.

Results

Conclusion