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Differences in engraftment with day-1 compared with day-2 melphalan prior to stem cell infusion in myeloma patients receiving autologous stem cell transplant

Bone Marrow Transplantation volume 55, pages 2132–2137 (2020)Cite this article

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Abstract

We conducted a retrospective study comparing posttransplant outcomes between myeloma patients receiving conditioning melphalan on day-2 vs day-1 for autologous stem cell transplant. Between January 2017 and December 2018, 201 patients received melphalan on day-2 and 166 on day-1 prior to stem cell infusion. Baseline disease and clinical characteristics between the two groups were similar. Although rates of hospitalization were similar between the cohorts, duration of hospital admission was longer for day-1 (median 7 days for day-1 vs 5 days for day-2, p = 0.003). Rates of fever were higher in the day-1 cohort (69% vs 49%, p = 0.0002). Time to platelet and neutrophil engraftment was significantly longer in the day-1 cohort (platelet engraftment median days 17 for day-1 vs 15 for day-2, p < 0.0001, neutrophil engraftment median days 16 for day-1 vs 16 for day-2, p = 0.025). Overall response rate was similar between the cohorts (99% for day-1, vs 100% for day-2). Day-2 melphalan infusions should be considered in preference for day-1 protocols, given the clinically significant delay in platelet and neutrophil engraftment and longer duration of hospitalization with day-1 infusions.

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Fig. 1: Study population.
Fig. 2: Engraftment post transplant.
Fig. 3: Transfusion requirements.
Fig. 4: Hematologic response at day 100.

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Acknowledgements

The study was approved by the Mayo Clinic institutional review board.

Funding

NCI SPORE MM SPORE 5P50 CA186781-04.

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Author notes

  1. These authors contributed equally: Abdullah S. Al Saleh, M Hasib Sidiqi

Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Abdullah S. Al Saleh, M. Hasib Sidiqi, JaeWon Lee, Angela Dispenzieri, Eli Muchtar, Francis K. Buadi, Rahma Warsame, Martha Q. Lacy, David Dingli, Nelson Leung, Wilson I. Gonsalves, Prashant Kapoor, Taxiarchis V. Kourelis, William J. Hogan, Shaji K. Kumar & Morie A. Gertz

  2. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Abdullah S. Al Saleh

  3. Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Nelson Leung

  4. Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Christel A. Skaer, Sarah K. Wittwer & Eapen Jacob

  5. Department of Pharmacy, Mayo Clinic, Rochester, MN, USA

    Robert C. Wolf

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  1. Abdullah S. Al Saleh
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Contributions

ASA, MHS designed the study, analyzed the data, wrote the first draft, and approved the final version of the paper. JL, EJ, CAS, SKW collected the data, revised the paper and approved the final version of the paper AD, EM, FKB, RW, MQL, DD, NL, WIG, PK, TVK, WJH, RW, and SKK performed patient management, revised the paper critically, and approved the final version of the paper; and MAG designed the study, analyzed the data, wrote the first draft, approved the final version of the paper, and performed patient management.

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Correspondence to Morie A. Gertz.

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Al Saleh, A.S., Sidiqi, M.H., Lee, J. et al. Differences in engraftment with day-1 compared with day-2 melphalan prior to stem cell infusion in myeloma patients receiving autologous stem cell transplant. Bone Marrow Transplant 55, 2132–2137 (2020). https://doi.org/10.1038/s41409-020-0916-3

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