This study compared retrospectively the effectiveness, toxicity and hematopoietic recovery after autologous peripheral blood stem cell transplantation (ASCT) of two consecutive peripheral blood stem cell mobilization regimens in newly diagnosed MM patients. Patients in group 1 (n=178) were treated with 4 g/m of cyclophosphamide (CY) plus G-CSF (5 μg/kg/day). Patients in group 2 (n=117) with 750 mg/m of VP16 plus G-CSF (10 μg/kg/day). Optimal mobilization, defined by a target number of 8 × 10 CD34+ cells/kg collected, was achieved in 62.4% and 89.7% of patients in groups 1 and 2, respectively (P<10). The median number of aphaeresis sessions was reduced from two in group 1 to one in group 2 (P<10). Grade neutropenia, febrile neutropenia and IV antibiotic use were significantly more frequent in group 1 than in group 2 (P<10). Red blood cell transfusion requirements were significantly greater in group 1 (P=0.007). The switch to VP16-G-CSF resulted in a significant reduction of the number of hospitalization days (P<10). Neutrophil and platelet recovery after ASCT occurred on days 11 and 12, respectively, in the two groups with no significant differences. VP+G-CSF allowed liberation of resources in the clinical and aphaeresis departments and demonstrated a better effectiveness-safety profile than CY+G-CSF.

Mucormycosis and invasive aspergillosis complicating severe aplastic anemia are aggressive infections associated to high mortality in the lack of rapid neutrophil and monocyte recovery. We report a child who had severe aplastic anemia complicated by sinusal invasive aspergillosis and by Rhizopus arrhizus, probably breakthrough gingivitis, which occurred under voriconazole. She underwent a rescue sibling bone marrow transplantation considered as the only chance for survive. Use of fludarabine-containing conditioning, granulocyte colonystimulating factor allowed rapid engraftment. Granulocyte transfusion and use of amphotericin BYvoriconazole association permitted infection control, which was favored by immune recovery.