Predictive factors for stem cell mobilization failure in multiple myeloma patients: A single center experience

Abstract

Background and aim: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been considered the standard of treatment care for patients with multiple myeloma (MM). Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. This is resulting in a lacking opportunity of cure in patients with MM. The aim of this study was to evaluate the factors which influence mobilization failure in patients with MM. Materials and methods: This study has been performed in a retrospective manner. Two hundred and thirty-four patients with diagnosed MM who underwent stem cell mobilization after induction chemotherapy at Hacettepe University Hospital between the years of 2003 and 2018 were evaluated. Results: A total of 234 patients were included in this study. The median age was 54 (32-76) years at the time of diagnosis. In 209 of 234 patients (89.3%) first mobilization trial was successful. At univariate analysis, among parameters identifiable before mobilization, male gender (p = 0.03), number of chemotherapy cycle before stem cell mobilization (p < 0.001), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p < 0.001) predicted mobilization failure. At multivariate analysis, number of chemotherapy cycle before stem cell mobilization (p = 0.03), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p = 0.02) retained independent predictive power. Conclusion: Detectable different clinical characteristics of MM patients before initiating mobilization may be predictors of poor mobilization. Therefore, the mobilization protocol should be evaluated on a patient basis. Minimization of exposure to chemotheraputic agents in MM patients, especially immunomodulatory agents, may increase CD34+ cell harvest yields.

Impact of Clinical Parameters and Induction Regimens on Peripheral Blood Stem-Cell Mobilization and Collection in Multiple Myeloma Patients

“…In the present study, this collection goal was unmet in only 4 of 790 patients (0.5%). As demonstrated in most previous analyses, age does not seem to be associated with mobilization failure (<2 × 10 6 CD34 + cells/kg) [37, 43, 45]. However, some studies indicate an adverse effect [41, 44].…”

“…The present study indicates that age >60 years is disadvantageous with higher collection goals (4 or 6 × 10 6 CD34 + cells/kg). We identified two other previous studies that considered the ISS stage; however, it was not associated with mobilization failure [43, 46] . In the present study, ISS stage III was associated with a lower probability of reaching the collection goal of ≥6 but not ≥4 × 10 6 CD34 + cells/kg.…”

“…First, the large sample size allows a statistically sufficient multiparametric analysis. Second, assessing multiple PBSC mobilization and collection parameters, beyond the widely established parameters of the “overall collection result” (CD34 + cell yield) and “mobilization failure,” engenders a broader picture of PBSC mobilization and collection [17, 27, 29, 31, 41, 43‒46, 49‒51]. Although a critical parameter, the CD34 + cell yield may not represent an adequate variable for PBSC mobilization and collection assessment.…”

Pre-mobilization platelet count predicts stem cell yield during mobilization in patients with multiple myeloma

“…Our results found that gender, disease subtype, ISS stage, treatment regimen, disease status, number of sessions, and presence of diabetes did not significantly affect CD34 + cell harvest yield, success rate, or quality, which aligns with the findings of some previous reports. 16 , 17 In contrast, when patients were ≤55 years old, the number of CD34 + cells collected, and the collection success rate were better than for those aged >55 years old. This demonstrated that younger patients might have a better reserve capacity for HSCs, so more HSCs could be released when mobilized for collection.…”

Risk Factors and Outcomes of Stem Cell Mobilization Failure in Multiple Myeloma Patients

“…Sensitivity analysis was performed using different definitions of mobilization failure to identify risk factors of CD34 + cell count yield <2 × 10 6 cells/kg [ 29 , 30 , 31 ], as well as CD34 + cell count collected being less than 5 × 10 6 cells/kg [ 32 , 33 , 34 ]. All data management and statistical analysis were performed using SAS 9.4 software (SAS Institute Inc., Cary, NC, USA) and STATA statistical software, version 15.1 (StataCorp, College Station, TX, USA).…”