TY - JOUR
T1 - Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies
AU - Hamadani, Mehdi
AU - Kochuparambil, S. Thomas
AU - Osman, Salman
AU - Cumpston, Aaron
AU - Leadmon, Sonia
AU - Bunner, Pamela
AU - Watkins, Kathy
AU - Morrison, Devi
AU - Speir, Ethan
AU - DeRemer, David
AU - Kota, Vamsi
AU - Jillella, Anand
AU - Craig, Michael
AU - Awan, Farrukh
N1 - Funding Information:
Financial disclosure: This work was supported in part by a Conquer Cancer Foundation of American Society of Clinical Oncology Career Development Award (to M.H.) and an American Society for Blood and Marrow Transplantation New Investigator Award (to M.H.). The authors have no conflicts of interest to disclose.
PY - 2012/7
Y1 - 2012/7
N2 - Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.
AB - Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.
KW - Autologous transplantation
KW - Chemomobilization
KW - High dose therapy
KW - Lenalidomide
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UR - http://www.scopus.com/inward/citedby.url?scp=84862147136&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2012.01.005
DO - 10.1016/j.bbmt.2012.01.005
M3 - Article
C2 - 22248715
AN - SCOPUS:84862147136
SN - 1083-8791
VL - 18
SP - 1128
EP - 1135
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 7
ER -