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

Bone Marrow Transplantation volume 48, pages 310–311 (2013)Cite this article

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Salvage second auto-SCT (ASCT) is a reasonable treatment option for patients with relapsed multiple myeloma (MM) when the duration of remission after initial ASCT is longer than 12–18 months.1, 2, 3 In addition, second salvage autologous transplant may be used in the context of progressive refractory myeloma for temporary disease control or for hematopoietic reconstitution after prior extensive therapy. Customarily, patients with MM who received prior alkylating agents or autologous transplantation with high-dose melphalan are not considered to be transplant candidates because of the deleterious effects of the drugs on stem cell collection.4, 5 Plerixafor is a chemokine receptor-4-antagonist that is approved by the FDA for use in combination with G-CSF for mobilization of CD34+ stem cells in patients with NHL and MM.6 We have explored the feasibility of stem cell collection with plerixafor and G-CSF in five consecutive heavily pretreated patients with MM who underwent prior ASCT with Melphalan-200. Patient characteristics, chemotherapy regimens and interval between first and second salvage transplant are shown in Table 1. All patients received G-CSF at a dose of 10 mcg/kg for 4 days in the morning and plerixafor (0.24 mg/kg) on the evening of the fourth and subsequent nights before apheresis. The number of apheresis procedures performed was two in two patients and three in three patients to achieve a minimum of 2 × 106 CD34+ cells/kg. All the patients engrafted successfully after the second ASCT with median times to neutrophil and platelet engraftment of 11 and 18 days, respectively. The number of apheresis procedures performed, number of CD34+cells collected and engraftment data are shown in Table 1.

Table1 Patients characteristics
Full size table

Our data show the feasibility of stem cell collection with G-CSF and plerixafor in heavily pretreated MM patients including melphalan-based prior ASCT. Recently, retrospective analysis by Basak et al.7 reported similar results where successful collection of at least 2.0 × 106 CD34+cells/kg was achievable in 70% of 30 patients who underwent prior ASCT for MM. Similarly, data from the University of Arkansas by Singhal et al.8 reported successful stem cell collection with G-CSF alone in 78% of 88 patients who underwent prior single or tandem autologous transplantation for MM. However, the collected stem cells were actually infused in only 12 of the original 88 patients included in the analysis. In contrast to our data, delayed platelet engraftment was seen in 11 of the 12 reported patients. It is not known if the delayed platelet engraftment observed in Singhal’s analysis is related to prior tandem transplants that all 12 patients received versus a plerixafor advantage for platelet engraftment in our patients. Several reports suggest that reduction of minimal residual disease after ASCT detected by allele-spin-specific oligonucleotide PCR or immunophenotypic evaluation may correlate with improved PFS.9, 10 If feasible, collection of less contaminated stem cell grafts with G-CSF and plerixafor after the first ASCT in MM patients with planned upfront tandem may have future clinical application in eliminating minimal residual disease and improved PFS.

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References

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Authors and Affiliations

  1. Florida Hospital Cancer Institute, Orlando, FL, USA

    Y Khaled, R Reynolds, V Reddy & M Solh

  2. Florida Cancer Specialists and Research Institute, Orlando, FL, USA

    A Al-Hazzouri

  3. Cancer Centers of Florida, Orlando, FL, USA

    A Mizrachi

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  1. Y Khaled
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  2. A Al-Hazzouri
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  3. A Mizrachi
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  4. R Reynolds
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Correspondence to Y Khaled.

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Khaled, Y., Al-Hazzouri, A., Mizrachi, A. et al. Stem cell mobilization in heavily pretreated multiple myeloma patients with prior high dose melphalan and auto-SCT. Bone Marrow Transplant 48, 310–311 (2013). https://doi.org/10.1038/bmt.2012.135

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