Stem cell mobilization in heavily pretreated multiple myeloma patients with prior high dose melphalan and auto-SCT

Khaled, Yasser; Al-Hazzouri, Ahmed; Mizrachi, Aviram; Reynolds, Robert B.; Reddy, Vijay; Solh, Melhem

doi:10.1038/bmt.2012.135

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…However the use of chemotherapy is not uniformly deleterious for the patient, as chemotherapy has also the potential to increase the efficacy of mobilization and to increase the yield of CD34+ cells 10,23,24 . The most efficacious cytostatic drug for remobilization in our group, among the ones tested was cytarabine, which is known to be very effective in the first‐line or second‐line setting, 25‐28 which however has never been tested in a group of selected patients who had already been exposed to myeloablative therapy (in the study of Parish et al cytarabine was used solely in one patient, 9 while in other studies in none 10‐13 ). In our analysis cytarabine was shown to be associated with lower risk of remobilization failure in general and, when single drugs were compared, also in comparison with cyclophosphamide.…”

Section: Discussionmentioning

confidence: 96%

“…There is limited data in the literature concerning both the efficacy of stem cell remobilization after previous myeloablative treatment, as well as short‐term and long‐term safety of salvage autoHSCT performed with use of these cells 9‐13 . Additionally, data on remobilization comes from studies analyzing patients suffering from relapsed multiple myeloma, as well as patients in complete remission designedly remobilized after the first transplant 14 .…”

Section: Introductionmentioning

confidence: 99%

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Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group

Drozd‐Sokołowska

Waszczuk‐Gajda

Topczewska

et al. 2021

J of Clinical Apheresis

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Background Salvage autologous hematopoietic stem cell transplantation (autoHSCT) may be used to treat relapse of multiple myeloma occurring after previous autoHSCT. When insufficient number of hematopoietic stem cells was stored from the initial harvest, remobilization of stem cells is necessary. Purpose The analysis of stem cell remobilization after previous autoHSCT. Patients and Methods Fifty‐eight patients, 60% males, median 59 years, were included. Median time interval between autoHSCT and remobilization was 42 months. The first remobilization was performed mostly after chemotherapy: cyclophosphamide (33%), cytarabine (43%), and etoposide (19%). Results The first remobilization was successful in 67% patients. About 19% patients required plerixafor rescue, among whom it allowed for successful harvesting in 14%. Use of cyclophosphamide, cytarabine, and etoposide allowed for successful remobilization in 53%, 84%, and 55% patients, respectively. Patients treated with cytarabine had the highest yield of CD34+ cells (median 7.5 × 106/kg vs 5.8 and 2.4 for etoposide and cyclophosphamide, P = .001). Higher percentage of patients was able to collect ≥2 × 106 CD34+ cells/kg during one leukapheresis after cytarabine (76% vs 21% for cyclophosphamide vs 36% for etoposide, P = .001). Cytarabine use was associated with lower risk of remobilization failure OR = 0.217, P = .02. Toxicity comprised mostly hematological toxicity (thrombocytopenia and neutropenia). One patient succumbed to septic shock. Conclusion Remobilization after previous autoHSCT is feasible only in a proportion of patients. Cytarabine is associated with the highest rate of successful mobilization and the highest yield of mobilized CD34+ cells. The toxicity requires careful surveillance of these patients.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group

Drozd‐Sokołowska

Waszczuk‐Gajda

Topczewska

et al. 2021

J of Clinical Apheresis

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“…Cyclophosphamide has also been used in stem cell remobilization in relapsed myeloma for salvage transplant, in patients who may have previously received intensive therapy, as reported by Baertsch et al and Drozd‐Sokolowska et al 22,23 It may have an ongoing role in this setting, although both authors reported infectious complications from this approach. Notably, Basak et al and Khaled et al have reported on the effectiveness of plerixafor in the remobilization setting, with omission of mobilizing chemotherapy 24,25 . Further studies are needed to fully determine the best remobilization regimen in relapsed myeloma.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, Basak et al and Khaled et al have reported on the effectiveness of plerixafor in the remobilization setting, with omission of mobilizing chemotherapy. 24,25 Further studies are needed to fully determine the best remobilization regimen in relapsed myeloma.…”

Section: Discussionmentioning

confidence: 99%

Are we choosing mobilization regimens for autologous stem cell transplantation in multiple myeloma wisely: A single center comparison of GCSF+/−plerixafor vs cyclophosphamide/GCSF+/−plerixafor

Yang

Dehghani

Hopman

et al. 2022

J of Clinical Apheresis

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Background: Autologous stem cell transplantation (ASCT) is a standard consolidation treatment for eligible patients with multiple myeloma (MM). There is no standardized mobilization regimen for collection of CD34+ stem cells, which is crucial to the success of ASCT. Cyclophosphamide/GCSF is an effective regimen, although reported associated toxicities include risk of febrile neutropenia (FN).Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. This single center, retrospective, quality improvement study evaluates mobilization and ASCT outcomes of MM patients who had undergone stem cell mobilization at KHSC with cyclophosphamide/GCSF+/Àplerixafor without antibiotics, cyclophosphamide/GCSF +/Àplerixafor with antibiotics, and GCSF+/Àplerixafor without antibiotics.Methods: A retrospective chart review was conducted evaluating 137 patients. The primary outcome measure was FN rates with mobilization. Balancing measures include CD34+ cell collected, plerixafor usage, days of apheresis and transplant outcomes. Chi-square, ANOVA, or Kruskal-Wallis methods were used to test statistical significance where appropriate.Results: Our study noted a higher total and day one CD34+ count in the two groups utilizing cyclophosphamide in mobilization. All nine cases of FN occurred in these two groups (P < .05). Addition of antibiotics decreased, but did not eliminate risk of FN. There were no significant differences in the rate of plerixafor usage and number of apheresis days. Difference in transplant outcomes, including engraftment and transfusion support, were statistically but not clinically significant. A larger sample size may be needed to explore this fully. There was no significant difference in length of transplant hospital stay. Conclusion:The elimination of cyclophosphamide from mobilization regimens for MM appears to significantly reduce FN rates, without increasing balancing measures such as total number of apheresis days, plerixafor usage, duration of transplant hospitalization or mortality outcomes.

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“…Remobilization to procure new cells is then required. However, data on the efficacy of remobilization are scarce [3][4][5][6][7][8]. Although some reports analysing the efficacy of salvage auto-HCT included patients in whom hematopoietic cells were harvested during remobilization performed after a prior auto-HCT [9][10][11][12][13][14][15], none of them reported on the specific outcomes of this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

Drozd‐Sokołowska

Gras

Zinger

et al. 2022

Bone Marrow Transplant

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Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.

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Stem cell mobilization in heavily pretreated multiple myeloma patients with prior high dose melphalan and auto-SCT

Cited by 8 publications

References 9 publications

Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group

Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group

Are we choosing mobilization regimens for autologous stem cell transplantation in multiple myeloma wisely: A single center comparison of GCSF+/−plerixafor vs cyclophosphamide/GCSF+/−plerixafor

Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation–study on behalf of CMWP of the EBMT

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