Abstract
Background aims
An optimal strategy for mobilizing hematopoietic stem cells in poorly mobilizing patients
with multiple myeloma (MM) and lymphoma has not yet been determined.
Methods
We retrospectively analyzed the efficacy and safety of etoposide combined with cytarabine
(etoposide 75 mg/m2, daily d1∼2; Ara-C 300 mg/m2, every 12 h d1∼2), plus pegfilgrastim (6 mg d6) in 32 patients with MM or lymphoma,
among whom 53.1% were defined as “proven poor mobilizers.”
Results
This approach resulted in adequate mobilization (≥2.0 × 106 CD34+ cells/kg) in 93.8% of patients and optimal mobilization (≥5.0 × 106 CD34+ cells/kg) in 71.9% of patients. A total of 100% of patients with MM reached at least
5 × 106 CD34+ cells/kg collected, the amount required for double autologous stem cell transplant.
In total, 88.2% of patients with lymphoma reached at least 2 × 106 CD34+ cells/kg collected, the amount required for a single autologous stem cell transplant.
This was achieved with a single leukapheresis in 78.1% of cases. A median peak number
of 42.0/μL circulating CD34+ cells and a median number of blood CD34+ cells counts in 6.7 × 106/L were collected among 30 successful mobilizers. Approximately 6.3% of patients required
plerixafor rescue, which was successful. Nine (28.1%) of the 32 patients suffered
grade 2∼3 infections, and 50% required platelet transfusions.
Conclusions
We conclude that chemo-mobilization with etoposide, Ara-C and pegfilgrastim in poorly
mobilizing patients with MM or lymphoma is very effective and has acceptable toxicity.
Key Words
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References
- Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019.Bone Marrow Transplant. 2019; 54: 1525-1552
- Management of mobilization failure in 2017.Transfus Apher Sci. 2017; 56: 836-844
- Proposed definition of 'poor mobilizer' in lymphoma and multiple myeloma: an analytic hierarchy process by ad hoc working group Gruppo Italiano Trapianto di Midollo Osseo.Bone marrow transplantation. 2012; 47: 342-351
- Poor peripheral blood stem cell mobilization affects long-term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation.Journal of clinical apheresis. 2018; 33: 29-37
- Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations.Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation. 2014; 20: 295-308
- Inferior prognosis in poor mobilizing myeloma patients.Transfusion and apheresis science: official journal of the World Apheresis Association: official journal of the European Society for Haemapheresis. 2020; 59102722
- Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation.Biol Blood Marrow Transplant. 2008; 14: 1045-1056
- UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy.Journal of Clinical Apheresis. 2018; 33: 46-59
- Plerixafor: what we still have to learn.Expert Opin Biol Ther. 2015; 15: 143-147
- A comparison of chemo-free strategy with G-CSF plus plerixafor on demand versus intermediate-dose cyclophosphamide and G-CSF as PBSC mobilization in newly diagnosed multiple myeloma patients: an Italian explorative cost analysis.Transfusion and apheresis science: official journal of the World Apheresis Association: official journal of the European Society for Haemapheresis. 2020; 59102819
- Single-dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma.Journal of Clinical Apheresis. 2019; 34: 579-588
- Higher efficacy of intermediate dose cytarabine + G-CSF compared to cyclophosphamide + G-CSF in hematopoietic stem cell mobilization in patients with multiple myeloma.Journal of Clinical Apheresis. 2020; 35: 246-254
- Intermediate-dose cytarabine plus G-CSF as mobilization regimen for newly diagnosed multiple myeloma and heavily pre-treated patients with hematological and non-hematological malignancies.Transfusion and apheresis science: official journal of the World Apheresis Association: official journal of the European Society for Haemapheresis. 2019; 58: 318-322
- Increased efficacy of stem cell chemomobilization with intermediate-dose cytarabine plus granulocyte colony-stimulating factor (G-CSF) compared with G-CSF alone in patients with multiple myeloma: Results of a randomized trial.Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation. 2019; 25: 248-255
- High efficacy of stem cell mobilization with etoposide+cytarabine plus G-CSF in patients with multiple myeloma.Front Oncol. 2022; 12825550
- Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia.Bone Marrow Transplant. 2012; 47: 231-235
- Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT.Bone Marrow Transplant. 2013; 48: 771-776
- Cytarabine + G-CSF is more effective than cyclophosphamide + G-CSF as a stem cell mobilization regimen in multiple myeloma.Bone Marrow Transplant. 2019; 54: 1107-1114
- Filgrastim-alone versus pegylated filgrastim-alone for autologous peripheral blood stem cells mobilization in newly diagnosed multiple myeloma patients.Wien Klin Wochenschr. 2017; 129: 545-551
- Long-active granulocyte colony-stimulating factor for peripheral blood hematopoietic progenitor cell mobilization.Expert Opin Biol Ther. 2014; 14: 757-772
- Pegfilgrastim vs filgrastim in PBSC mobilization for autologous hematopoietic SCT: a systematic review and meta-analysis.Bone Marrow Transplant. 2015; 50: 523-530
- Dose response of pegfilgrastim in Japanese breast cancer patients receiving six cycles of docetaxel, doxorubicin, and cyclophosphamide therapy: a randomized controlled trial.Support Care Cancer. 2015; 23: 2891-2898
- Proposed definition of 'poor mobilizer' in lymphoma and multiple myeloma: an analytic hierarchy process by ad hoc working group Gruppo ItalianoTrapianto di Midollo Osseo.Bone Marrow Transplant. 2012; 47: 342-351
- International uniform response criteria for multiple myeloma.Leukemia. 2006; 20: 1467-1473
- Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for malignant lymphoma 2021 (English version).Chin J Cancer Res. 2021; 33: 289-301
- Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation.Bone Marrow Transplant. 2014; 49: 865-872
- Comparison of survival between autologous and allogeneic stem cell transplantation in patients with relapsed or refractory B-Cell non-Hodgkin lymphoma: a meta-analysis.Cell Transplant. 2020; 29963689720975397
- The outcome of patients with Hodgkin lymphoma and early relapse after autologous stem cell transplant has improved in recent years.Leukemia. 2022; 36: 1646-1653
- Role of stem cell transplantation in multiple myeloma.Cancers (Basel). 2021; 13
- Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma.Bone Marrow Transplant. 2010; 45: 1396-1403
- Poor mobilization of peripheral blood stem cells is a risk factor for worse outcome in lymphoma patients undergoing autologous stem cell transplantation.Leuk Lymphoma. 2003; 44: 815-820
- Clinical outcomes of multiple myeloma patients who undergo autologous hematopoietic stem cell transplant with G-CSF or G-CSF and plerixafor mobilized grafts.Am J Hematol. 2020; 95: 198-204
- Factors affecting successful mobilization with plerixafor: an Italian prospective survey in 215 patients with multiple myeloma and lymphoma.Transfusion. 2014; 54: 331-339
- Haematopoietic stem cell mobilization with plerixafor and G-CSF in patients with multiple myeloma transplanted with autologous stem cells.Eur J Haematol. 2011; 86: 488-495
- Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma.Blood. 2009; 113: 5720-5726
- Systematic review of randomized controlled trials of hematopoietic stem cell mobilization strategies for autologous transplantation for hematologic malignancies.Biol Blood Marrow Transplant. 2012; 18: 1191-1203
- Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score.Bone Marrow Transplant. 2018; 53: 461-473
- Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: a multicenter report by the Polish Myeloma Study Group.J Clin Apher. 2021; 36: 443-453
- Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers.Bone Marrow Transplant. 2013; 48: 915-921
- Low-dose cyclophosphamide versus intermediate-high-dose cyclophosphamide versus granulocyte colony-stimulating factor alone for stem cell mobilization in multiple myeloma in the era of novel agents: a multicenter retrospective study.Transplant Cell Ther. 2021; 27: 244.e1-244.e8
Article info
Publication history
Published online: May 20, 2023
Accepted:
April 28,
2023
Received:
February 15,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.
