Mobilization of peripheral blood progenitor cells with vinorelbine and granulocyte colony-stimulating factor in multiple myeloma patients is reliable and cost effective

Abstract

Summary:Cyclophosphamide with granulocyte colony stimulating factor (G-CSF) is commonly used to mobilize stem cells in multiple myeloma. Timing of collection is variable and incidence and severity of side effects is substantial. To optimize timing of collection, to reduce side effects and to limit costs of the procedure, we evaluated vinorelbine, a drug shown to have activity in multiple myeloma, in combination with G-CSF as mobilizing regimen. A total of 19 consecutive patients with advanced stage multiple myeloma received one dose of vinorelbine 35 mg/m 2 intravenously on day 1 in an outpatient setting and G-CSF 10 lg/kg/day from day 4 divided in two daily doses. Median CD34+ cell blood counts measured on day 8 of mobilization were 142 Â 10 6 /l (range 57-467). One 15-l apheresis on day 8 resulted in sufficient stem cells (median 11.1 Â 10 6 CD34+ cells/kg, range 6.2-36.0 prior and median 7.5 Â 10 6 CD34+ cells/kg, range 4.0-20.2 postpositive CD34+ cell selection) for transplantation. Hematopoietic recovery was swift with ANC 40.5 Â 10 9 /l on day 11 median (range 10-15) and platelets 420 Â 10 9 /l on day 12 median (range 10-15) after reinfusion of the stem cells on day 0. No episodes of febrile neutropenia were observed during mobilization. In our institutions cost reduction for the procedure was about 1700 euros compared to the mobilization with cyclophosphamide and G-CSF. Vinorelbine and G-CSF allow precise timing and harvesting of sufficient stem cells, and might be an alternative to cyclophosphamide in the mobilization of stem cells for autologous transplantation in multiple myeloma.

Improving stem cell mobilization strategies: future directions

“…43,44 After chemomobilization, the lapse of time before the number of CD34 þ cells peaks varies substantially between patients. 25,43,44 WBC counts and CD34 þ cell counts must be monitored over the course of several days to determine when to begin apheresis. 44 Algorithms intended to reduce the incidence of unanticipated PBSC collections and to streamline care by predicting the timing of apheresis after chemomobilization have been used with limited success.…”

“…25,43,44 WBC counts and CD34 þ cell counts must be monitored over the course of several days to determine when to begin apheresis. 44 Algorithms intended to reduce the incidence of unanticipated PBSC collections and to streamline care by predicting the timing of apheresis after chemomobilization have been used with limited success. 39 Hence, patients who undergo mobilization with chemotherapy plus cytokines often require unscheduled apheresis sessions on weekends, a practice that necessitates inefficient allocation of hospital resources and staff.…”

“…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. 26,[45][46][47] The question of whether failure rates after chemomobilization are lower than failure rates after cytokine-only mobilization has not been adequately studied.…”

Mobilization of PBSCs with chemotherapy and recombinant human G-CSF: a randomized evaluation of early vs late administration of recombinant human G-CSF

“…We may therefore speculate that this provided us with more consistent results compared with those studies reported previously using different doses, regimens and timing of rhG-CSF. [16][17][18][19][20][21][23][24][25] We concluded that PBSC mobilization after the 'late' use of rhG-CSF is an effective approach, and that in routine clinical practice the late use of rhG-CSF may therefore be used for PBSC collections after chemotherapy-based mobilization regimens in this cost-conscious era.…”

“…It has to be noted that in most of these studies, the primary objective was not to evaluate 'late' administration of rhG-CSF. [16][17][18][19][20][21] These studies have evaluated the 'late' use of rhG-CSF (4 days after chemotherapy), at varied doses and schedules with comparable results with those obtained after starting rhG-CSF immediately after chemotherapy. 18,19,21 Mollee et al 16 compared CY þ rhG-CSF with CE þ rhG-CSF of 10 mg/kg once daily for PBSC mobilization in patients with lymphoma.…”