Salvage second autologous transplantation for patients with relapsed multiple myeloma (MM) after prior autologous transplantation has shown to be beneficial in particular if the first remission is longer than 12-18 months. In addition second salvage autologous transplant may be used in the contest of progressive refractory myeloma for temporarily disease control or for hematopoietic reconstitution after prior extensive therapy. Customarily, patients with multiple myeloma who received prior alkylating agents or autologous transplantation with high dose Melphalan are considered non transplant candidate because of the deleterious effects on stem cell collection. Plerixafor is a chemokine receptor -4- antagonist which is approved by FDA for use in combination with G-CSF for mobilization of CD34+ stem cells in patients with NHL and multiple myeloma. We have explored the feasibility of Plerixafor and G-CSF in stem cell collection for second salvage autologous transplantation in 4 consecutive patients with multiple myeloma who underwent prior extensive therapy including prior autologous transplantation with Melphalan-200. Patient characteristics, chemotherapy used and interval between first and second salvage transplant are shown in Table 1. All Patients received GCSF at dose of 10 mcg/KG for 4 days in AM, Plerixafor on the evening of the 4th night and subsequent nights prior to apheresis at a dose of 0.24 mg/kg. The number of apheresis procedures were 2 in two patients and 3 in two patients. The number of CD34 + cells collected were 4.25, 3.06, 3.63, 3.78 million cells/Kg. All the patients engrafted successfully after the second transplant. Neutrophils engraftement were at day 10, 12, 12 and 11 while platelet engraftment were at day 10, 15, 32 and 19 respectivlely for the four patients. Our Data shows the feasibility of stem cell collection in heavily pretreated MM patients including high dose Melphalan and autologous stem cell transplantation. Prospective studies are needed to confirm such feasibility. Such approach may have future clinical application in eliminating minimal residual disease after the first autologous transplant when used in MM patients with planned upfront tandem autologous transplant.Table 1Patient #AGEInduction pre 1st TransplantMobilization RegimenFirst Transplant TypeMaintenance/Relapse treatmentRe-InductionInterval between transplants (Years)146VAD X4 then Thalidomide for 1 yearCytoxan/G-CSFSingleThalidomid then Lenalidomide maintenanceRVD × 38.57266VAD X4Cytoxan/G-CSFPlanned TandemDex/Thal followed by Bro/DoxilMPV-Rituximab4.77356Thal/Dex then Bro/Dex then MPCytoxan/G-CSFSingleDex/Thal then RVD×3 then VD-PACEMPV-Rituximab ×24.43467Lenalidomide/Dex × 4G-CSFSingleLenalidomide maintennace for 15 monthsRVD × 4,VD-PACE ×21.75X indicates number of cycles; RVD, lenalidomide, Bortezomib, Dex.; Thal, Thalidomide; MPV, Melphalan, Prednisone , Bortezomib; PACE, Cisplatin, Doxorubicin, Cytoxan, Etoposide; Bro, Brotezomib. Open table in a new tab X indicates number of cycles; RVD, lenalidomide, Bortezomib, Dex.; Thal, Thalidomide; MPV, Melphalan, Prednisone , Bortezomib; PACE, Cisplatin, Doxorubicin, Cytoxan, Etoposide; Bro, Brotezomib.
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