Stem Cell Mobilization for Multiple Myeloma Patients Receiving Daratumumab-Based Induction Therapy: A Real- World Experience

Thurlapati, Aswani; Roubal, Kiera; Davis, James A.; Shah, Syed Zawar; Smith, Deidra; McGann, Mary; Gaffney, Kelly J; Cendagorta, Alyssa; Maldonado, Andy; Weeda, Erin R.; Hashmi, Hamza

doi:10.1016/j.jtct.2023.02.013

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Another study reported a poorer performance of D-VTd vs. VCd as to mobilization metrics (e.g., amount of circulating peripheral CD34+ cells on apheresis day) [41]. In our study, use of plerixafor rescue was more frequent in D-RVd patients (38% vs. 28%, p = 0.3052), which is in line with the majority of previous reports [6,31,[33][34][35]37,[39][40][41]. On the contrary, Hodroj et al reported similar rates of plerixafor usage between regimens with or without daratumumab [49].…”

Section: Discussionsupporting

confidence: 91%

“…This was also consistently observed in the subgroup analysis: 35% lower for patients mobilized with gemcitabine (p = 0.0714) and 42% lower for the vinorelbine subgroup (p = 0.0005). Other studies reported similar results [30][31][32]37,41]. For instance, Cavallaro et al showed lower pre-harvest concentrations of peripheral CD34+ cells in patients treated with D-VTd vs. VTd (26 vs. 76 × 10 6 /µL) [31].…”

Section: Discussionmentioning

confidence: 60%

“…A higher yield of collected CD34+ cells allows for performing more than one ASCT, re-transfusion in case of engraftment failure, and administration of a higher dose of CD34+ cells, which leads to better engraftment [27][28][29]. Previous reports have shown that daratumumab might impair stem cell mobilization and collection, leading to an increased requirement for plerixafor use, impaired stem cell engraftment, and an increased complication rate during hospitalization [6,[30][31][32][33][34][35][36][37][38][39][40][41]. However, current mobilization schedules, as well as standards for induction treatment, are heterogeneous among institutions.…”

Section: Introductionmentioning

confidence: 99%

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Daratumumab during Myeloma Induction Therapy Is Associated with Impaired Stem Cell Mobilization and Prolonged Post-Transplant Hematologic Recovery

Mehl,

Akhoundova,

Bacher

et al. 2024

Cancers

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Daratumumab is being increasingly integrated into first-line multiple myeloma (MM) induction regimens, leading to improved response depth and longer progression-free survival. Autologous stem cell transplantation (ASCT) is commonly performed as a consolidation strategy following first-line induction in fit MM patients. We investigated a cohort of 155 MM patients who received ASCT after first-line induction with or without daratumumab (RVd, n = 110; D-RVd, n = 45), analyzing differences in stem cell mobilization, apheresis, and engraftment. In the D-RVd group, fewer patients successfully completed mobilization at the planned apheresis date (44% vs. 71%, p = 0.0029), and more patients required the use of rescue plerixafor (38% vs. 28%, p = 0.3052). The median count of peripheral CD34+ cells at apheresis was lower (41.37 vs. 52.19 × 106/L, p = 0.0233), and the total number of collected CD34+ cells was inferior (8.27 vs. 10.22 × 106/kg BW, p = 0.0139). The time to recovery of neutrophils and platelets was prolonged (12 vs. 11 days, p = 0.0164; and 16 vs. 14 days, p = 0.0002, respectively), and a higher frequency of erythrocyte transfusions (74% vs. 51%, p = 0.0103) and a higher number of platelet concentrates/patients were required (4 vs. 2; p = 0.001). The use of daratumumab during MM induction might negatively impact stem cell mobilization and engraftment in the context of ASCT.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Daratumumab during Myeloma Induction Therapy Is Associated with Impaired Stem Cell Mobilization and Prolonged Post-Transplant Hematologic Recovery

Mehl,

Akhoundova,

Bacher

et al. 2024

Cancers

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“…As previously reported, chemomobilization was associated with less frequent administration of plerixafor as well as lower total cell counts 29 . Notably, in comparison to the MASTER and GRIFFIN trials, plerixafor was not used as an upfront strategy in our patient cohort.…”

Section: Discussionsupporting

confidence: 63%

“…As previously reported, chemomobilization was associated with less frequent administration of plerixafor as well as lower total cell counts. 29 Notably, in comparison to the MASTER and GRIFFIN trials, plerixafor was not used as an upfront strategy in our patient cohort. Furthermore, the low incidence of primary mobilization failure is similar to those published for steady state and chemomobilization.…”

Section: Discussionmentioning

confidence: 96%

Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Teipel,

Rieprecht,

Trautmann‐Grill

et al. 2023

Transfusion

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BackgroundThe incorporation of anti‐CD38 monoclonal antibodies (mAb) in induction regimens of newly diagnosed transplant‐eligible multiple myeloma (MM) patients has been established as a new standard. However, the optimal strategy of stem cell mobilization in this context is not yet clear.Study Design and MethodsFrom May 2020 till September 2022, we retrospectively reviewed patients receiving anti‐CD38 mAb‐based induction therapy followed by stem cell mobilization either in a steady‐state protocol (SSM) using 10 μg/kg granulocyte colony‐stimulating factor (G‐CSF) for 5 days or in a chemotherapy‐based protocol (CM) using 1–4 g/m2 cyclophosphamide and G‐CSF.ResultsOverall, 85 patients (median age 61 years) were included in the analysis. In total, 90 mobilization attempts were performed, 42 with SSM and 48 with CM. There was no significant difference in the median concentration of CD34+ cells in peripheral blood (PB) prior to apheresis between SSM and CM (61/μL vs. 55.4/μL; p = .60). Cumulative CD34+ yields did not differ between the groups with median of 6.68 and 6.75 × 106/kg body weight, respectively (p = .35). The target yield (≥4 × 106 CD34+ cells/kg body weight) was reached in 88% (CM) and 86% (SSM), with a high proportion even after a single apheresis session (76% vs. 75%).Plerixafor was found to be more frequently used in SSM (52%) than in CM (23%; p < .01). A total of 83 patients underwent autologous transplantation and all were engrafted.ConclusionsStem cell collection in patients undergoing anti‐CD38‐based induction therapy is feasible with either CM or SSM, although SSM more frequently requires plerixafor.

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Predictive factors for peripheral blood stem cell mobilization in multiple myeloma in the era of novel therapies: A single‐center experience

He,

Jiang,

Zhao

et al. 2024

Cancer Medicine

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ObjectiveMultiple myeloma (MM) is the leading indication of autologous hematopoietic stem cell transplantation. The aim of this study was to determine the incidence of mobilization failure and characterize the risk factors associated with poor mobilization (PM) of MM patients in novel therapies era.MethodsWe conducted a retrospective study of 211 MM patients who received their first peripheral blood stem cells (PBSC) mobilization at our single center. The following data were collected: age, gender, clinical stage, disease status, complete blood cell count, induction regimen, CD34+ cell count in peripheral blood (PB), and PBSC collections.ResultsIn addition to conventional drugs, 22 (10.4%) patients received daratumumab containing induction, and 33 (15.6%) patients used plerixafor for poor mobilization (pre‐apheresis PB CD34+ cells <20/μL). Failure of collection occurred in 24 (11.4%) patients and was correlated with low white blood cell (WBC), ≥3 cycles of lenalidomide treatment before mobilization, steady‐state mobilization and nouse of plerixafor are associated with mobilization failure. Daratumumab‐based induction treatment ≥2 courses, albumin >41 g/L before mobilization, and steady‐state mobilization were risk factors for PM in subgroups of patients treated with lenalidomide for <3 courses. In addition, Hepatitis B virus infection at baseline, thalassemia and measurable residual disease positivity were recognized as predictive factors for PM in subset of chemo‐mobilization patients.ConclusionIn addition to some well‐recognized risk factors, baseline WBC count and daratumumab exposure ≥2 courses before mobilization were revealed as the predictive factors of mobilization failure, providing consultation for preemptive use of plerixafor.

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Stem Cell Mobilization for Multiple Myeloma Patients Receiving Daratumumab-Based Induction Therapy: A Real- World Experience

Cited by 12 publications

References 12 publications

Daratumumab during Myeloma Induction Therapy Is Associated with Impaired Stem Cell Mobilization and Prolonged Post-Transplant Hematologic Recovery

Daratumumab during Myeloma Induction Therapy Is Associated with Impaired Stem Cell Mobilization and Prolonged Post-Transplant Hematologic Recovery

Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

Predictive factors for peripheral blood stem cell mobilization in multiple myeloma in the era of novel therapies: A single‐center experience

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