Stem Cell Mobilization in Multiple Myeloma: Comparing Safety and Efficacy of Cyclophosphamide +/- Plerixafor versus Granulocyte Colony-Stimulating Factor +/- Plerixafor in the Lenalidomide Era

Abstract

Growth factor and chemotherapy-based stem cell mobilization strategies are commonly used to treat patients with multiple myeloma. We retrospectively compared 398 patients mobilized between 2017 and 2020 using either cyclophosphamide (4 g/m2) plus granulocyte colony-stimulating factor (G-CSF) or G-CSF alone, with on demand plerixafor (PXF) in both groups. Although total CD34+yield was higher after chemomobilization compared with G-CSF +/- PXF (median, 13.6×106/kg versus 4.4×106/kg; P < .01), achievement of≥2×106CD34+ cells (95% versus 93.7%; P=.61) and rates of mobilization failure (5% versus 6.3%; P=.61) were similar. Fewer patients required PXF with chemomobilization (12.3% versus 49.5%;P < .01), and apheresis sessions were fewer (median, 1 [range, 1 to 4] versus 2 [range, 1 to 5]). The rate of complications, including neutropenic fever, emergency department visits, and hospitalizations, was higher after chemomobilization (30% versus 7.4%;P < .01). Previous use of ≤6 cycles of lenalidomide did not impair cell yield in either group.The median cost of mobilization was 17.4% lower in the G-CSF +/- PXF group (P=.01).Between group differences in time to engraftment were not clinically significant. Given similar rates of successful mobilization, similar engraftment time, and less toxicity and lower costs compared with chemomobilization, G-CSF with on-demand PXF may be preferable in myeloma patients with adequate disease control and limited lenalidomide exposure.