A comparison of toxicity following two different doses of cyclophosphamide for mobilization of peripheral blood progenitor cells in 116 multiple myeloma patients

Abstract

Summary:High-dose cyclophosphamide (HDC) has been shown to be an effective regimen for collecting PBPC in multiple myeloma (MM) patients, but the optimal dose to be used remains controversial. Two historical cohorts of MM patients who received G-or GM-CSF and HDC at the dose of either 7 g/m 2 (HDC7, n = 74) or 4 g/m (HDC4, n = 42) were compared. As patients in the HDC4 group were more likely to have received G-CSF than GM-CSF (P Ͻ 10) and fewer previous alkylating agents (P = 0.004), multivariate logistic regression analysis was performed. In the HDC4 group, patients had a shorter median duration of neutropenia (P Ͻ 10

Improving stem cell mobilization strategies: future directions

“…Desikan et al 29 reported increased hospitalization and transfusions in patients who underwent mobilization with G-CSF plus high-dose CY than with G-CSF alone. In addition, Jantunen et al 41 and Fitoussi et al 40 reported more hospital days, more days of i.v. antibiotics and more blood transfusions in patients who underwent mobilization with higher doses of chemotherapy than in those who received lower doses.…”

“…Compared with mobilization regimens using G-CSF alone, chemomobilization is associated with increased morbidity, greater risk of infection, more hospital admissions, transfusions, antibiotic therapy and considerably greater cost overall. 29,[39][40][41][42] Although treatment-related mortality is rare, significant morbidity related to neutropenia that can often require hospitalization has been described, and many reports point to greater resource utilization with chemomobilization than with cytokine-alone mobilization. 29,37,39 Koc et al 39 found that although treatment with CY plus G-CSF resulted in greater stem cell yield than did treatment with GM-CSF plus G-CSF, it also caused greater morbidity.…”

“…29,39 As a result, this mobilization strategy requires increased resource use, hospitalizations, transfusions and the use of antibiotic therapy. 29,[39][40][41][42] Furthermore, variation among individual responses to chemomobilization can result in irregular collection schedules that can increase resource utilization and potentially delay transplantation. 43,44 The utility of all current mobilization regimens is limited by their high failure rates, which are estimated to be from 5 to 30%, regardless of the approach.…”

The VAD chemotherapy regimen plus a G-CSF dose of 10 μg/kg is as effective and less toxic than high-dose cyclophosphamide plus a G-CSF dose of 5 μg/kg for progenitor cell mobilization: results from a monocentric study of 82 patients

“…This strategy is very efficient for CD34 þ cells mobilization and may help to treat patient with MM, but is associated with several side -effects such as nausea, emesis, neutropenic fever, sepsis and hemorragic cystitis with mortality rates of 1-2%, and needs supportive care. [9][10][11] The VAD regimen is a polychemotherapy commonly used for patients with MM. [12][13] Combined to G-CSF, VAD administration displays the potential to mobilize PBSC with a theoretically reduced toxicity as compared to HD-CY.…”

Low-dose or intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor for progenitor cell mobilisation in patients with multiple myeloma

“…However, high-dose CY is associated with significant toxicity. 7,9 Recently, Fitoussi et al 9 showed that intermediate-dose CY (ID-CY) (4 g/m 2 ) plus growth factor was equally effective as high-dose CY in mobilising progenitor cells in myeloma patients but was less toxic.Mobilisation with CY 4 g/m 2 plus G-CSF is, however, also associated with significant toxicity and need for supportive care. We hypothesised whether low-dose CY (LD-CY) (up to 2 g/m 2 ) could be as effective and, less toxic mobilisation regimen in patients with newly diagnosed MM.…”