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Stem Cell Procurement

Hematopoietic stem cell mobilization with intravenous melphalan and G-CSF in patients with chemoresponsive multiple myeloma: report of a phase II trial

Bone Marrow Transplantation volume 35, pages 441–447 (2005)Cite this article

Summary:

Multiple myeloma (MM) is an incurable hematologic malignancy for which autologous hematopoietic stem cell transplantation (HCT) is a standard therapy. The optimal method of stem cell mobilization is not defined. We evaluated intravenous melphalan (60 mg/m2), the most effective agent for MM, and G-CSF (10 μg/kg/day) for mobilization. End points were safety, adequacy of CD34+ collections, MM response, and contamination of stem cell components (SCC). In total, 32 patients were mobilized. There were no deaths or significant bleeding episodes; 14 patients (44%) required hospitalization for neutropenic fever. Median days of grade 3 or 4 neutropenia or thrombocytopenia were 7 (2–20) and 8 (3–17). Median mobilization days, CD34+ cells/kg and total leukaphereses were 16 (12–30), 12.1 million (2.6–52.8), and 2 (1–5) respectively. Four patients (12.5 %) failed to achieve the target of 4 million CD34+ cells/kg in five leukaphereses. Reduction in myeloma was seen in 11 patients (34%) with 3 (9%) achieving complete response; 15 (47%) maintained prior responses. Estimated MM contamination per SCC (N=48) was 0.0009% (range 0–0.1) and 0.21 × 10 4 cells per kg (range 0–41.2). Increased contamination was associated with increased patient age. This strategy for mobilization is feasible, frequently requires hospitalization and transfusion, and controls disease in most patients.

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Acknowledgements

We thank the MSKCC Cytotherapy Laboratory for assistance with stem cell samples and the Memorial Hospital nurses in the Adult Day Hospital and in-patient services who cared for our patients. This work was supported by NIH Grant CA05826, FDA Grant R01-002174-02 (RLC), the Graziano Fund, the Multiple Myeloma Research Foundation, the Mel Stottlemyre Myeloma Research Fund, the Donald Stein Myeloma Research Fund, the Werner and Elaine Dannheiser Fund for Research on the Biology of Aging of the Lymphoma Foundation, and Amgen.

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Author notes

  1. S Gupta and P Zhou: Both SG and PZ contributed equally to this work.

Authors and Affiliations

  1. Hematology Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    S Gupta, H Hassoun, T Kewalramani, L Reich, S Costello, L Drake, V Klimek, M Dhodapkar, S D Nimer & R L Comenzo

  2. Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    P Zhou, N Kalakonda & S D Nimer

  3. Laboratory of Tumor Immunology and Immunotherapy, The Rockefeller University, New York, NY, USA

    M Dhodapkar

  4. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    J Teruya-Feldstein, C Hedvat & D Filippa

  5. Department of Clinical Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    M Fleisher, S D Nimer & R L Comenzo

  6. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    J Qin

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Correspondence to R L Comenzo.

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Gupta, S., Zhou, P., Hassoun, H. et al. Hematopoietic stem cell mobilization with intravenous melphalan and G-CSF in patients with chemoresponsive multiple myeloma: report of a phase II trial. Bone Marrow Transplant 35, 441–447 (2005). https://doi.org/10.1038/sj.bmt.1704779

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