Etoposide combined with cytarabine and pegfilgrastim for poorly mobilizing patients with multiple myeloma and lymphoma: A prospective multicentre study

Abstract

SummaryA chemotherapy‐based mobilization regimen in patients who mobilize poorly, based on etoposide, cytarabine and pegfilgrastim (EAP), has recently been introduced. The aim of this prospective study was to investigate the efficacy and safety of the EAP regimen in patients with poorly mobilizing multiple myeloma (MM) or lymphoma. This single‐arm clinical trial was performed at eight public hospitals in China and was registered as a clinical trial (NCT05510089). The inclusion criteria were; (1) diagnosis of MM or lymphoma, (2) defined as a ‘poor mobilizer’ and (3) aged 18–75 years. The EAP regimen consisted of etoposide 75 mg/m2/day on days 1–2, cytarabine 300 mg/m2 every 12 h on days 1–2 and pegfilgrastim 6 mg on day 6. The primary endpoint of the study was the ratio of patients achieving adequate mobilization (≥2.0 × 106 CD34+ cells/kg). From 1 September 2022 to 15 August 2023, a total of 58 patients were enrolled, 53 (91.4%) achieved adequate mobilization, while 41 (70.7%) achieved optimal mobilization with a median number of cumulative collected CD34+ cells was 9.2 (range 2.1–92.7) × 106/kg and the median number of apheresis per patient of 1.2. The median time from administration of the EAP regimen to the first apheresis was 12 days. Approximately 8.6% of patients required plerixa for rescue, which was successful. Twelve (20.7%) of the 58 patients suffered grade 2–3 infections, while 25 (43.1%) required platelet transfusions. The duration of neutrophil and platelet engraftment was 11 days. In conclusion, these results suggest that the EAP mobilization regimen might be a promising option for poorly mobilizing patients with MM or lymphoma.

Efficacy and safety of stem cell mobilization with etoposide +cytarabine plus G-CSF in poor mobilizers with relapsed or refractory lymphoma

“…It has been reported that high-dose cytotoxic agents utilized in mobilization may lead to delayed engraftment following ASCT. However, in our study, the day to neutrophil engraftment post-transplantation was comparable to Ye’s EAP protocol (median: 10 vs. 10 days) ( 34 ), and consistent with other reports ( 16 , 24 , 35 ). Several studies have reported that higher number of infused CD34+ cells was associated with faster hematologic recovery ( 30 , 36 ).…”

“…Ye et al. recently reported the outcomes of reduced dosage etoposide (75 mg/m2/day, d1-2)+cytarabine (300mg/m2 q12h, day1-2) plus pegfilgrastim in a small cohort of poorly mobilizing MM ( n =32) and lymphoma ( n =26) patients ( 34 ). Among the 26 lymphoma patients, 21(80.8%) collected adequate amount of CD34+ cells, while only 12(46.2%) achieved optimal mobilization.…”