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

Abstract

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.

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

“…The results of the EAP regimen were encouraging as it was shown to be well tolerated with a low incidence of grade 2–3 infections. In addition, the incidence of grade 3–4 haematological adverse events was similar or lower to that reported for other chemo‐based mobilization treatments 11,20,21 . However, these cross‐trial comparisons should be interpreted with caution as 43.1% of our patients required platelet transfusions, with the rate of these transfusions being higher than those reported by other studies 11,22 .…”

“…In addition, the incidence of grade 3-4 haematological adverse events was similar or lower to that reported for other chemo-based mobilization treatments. 11,20,21 However, these cross-trial comparisons should be interpreted with caution as 43.1% of our patients required platelet transfusions, with the rate of these transfusions being higher than those reported by other studies. 11,22 This finding can be explained by the poor mobilizers requiring more platelet transfusions and the combined use of etoposide and cytarabine.…”

Cyclophosphamide versus cytarabine mobilization of hematopoietic stem cells with G-CSF stimulation in myeloma patients subjected to autologous stem cell transplantation

“…The protocol with cytarabine demonstrated better efficacy and acceptable toxicity [18]. The same authors showed the effectiveness of remobilization regimen with cytarabine after the previous auto-HSCT [19].…”

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

“…In this situation, our data would support the addition of antibiotics prophylaxis to decrease infection risk. 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.…”