Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Stem Cell Procurement

The VAD chemotherapy regimen plus a G-CSF dose of 10 μg/kg is as effective and less toxic than high-dose cyclophosphamide plus a G-CSF dose of 5 μg/kg for progenitor cell mobilization: results from a monocentric study of 82 patients

Bone Marrow Transplantation volume 37, pages 725–729 (2006)Cite this article

Abstract

A study was conducted to compare the efficiency and toxicity of two peripheral blood stem cell (PBSC) mobilization procedures for newly diagnosed patients with multiple myeloma. Patients from group 1 (n=51) were treated by high-dose cyclophosphamide (HD-CY) plus G-CSF (5 μg/kg/day), and the second group (n=31) by VAD regimen plus G-CSF administration (10 μg/kg/day). Successful mobilization, defined by a minimal count of 2.5 × 106 CD34+ cells/kg collected, was achieved in 96 and 90% of patients in groups 1 and 2, respectively (P=0.15). The mean peripheral blood CD34+ cells concentration and the mean CD34+ cells/kg collected were higher in group 2 than in the group 1 (P=0.05). The mean number of leukaphereses necessary to collect a count of 2.5 × 106 CD34+ cells/kg was reduced in group 2 compared to group 1. Adverse events, blood products consumption and time spent in the hospital were significantly greater after HD-CY. In conclusion, VAD plus a G-CSF dose of 10 μg/kg administration seems preferential to HD-CY plus a G-CSF dose of 5 μg/kg for PBSC collection because of equivalent or better efficiency in stem cell mobilization, strong favorable toxicity profile and reduced cost.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med 2003; 349: 2495–2502.

    Article  CAS  PubMed  Google Scholar 

  2. Barlogie B, Jagannath S, Vesole DH, Naucke S, Cheson B, Mattox S et al. Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma. Blood 1997; 89: 789–793.

    CAS  PubMed  Google Scholar 

  3. Putkonen M, Rauhala A, Itala M, Kauppila M, Pelliniemi TT, Remes K . Double versus single autotransplantation in multiple myeloma; a single center experience of 100 patients. Haematologica 2005; 90: 562–563.

    PubMed  Google Scholar 

  4. Haas R, Mohle R, Fruhauf S, Goldschmidt H, Witt B, Flentje M et al. Patient characteristics associated with successful mobilizing and autografting of peripheral blood progenitor cells in malignant lymphoma. Blood 1994; 83: 3787–3794.

    CAS  PubMed  Google Scholar 

  5. Ketterer N, Salles G, Raba M, Espinousse D, Sonet A, Tremisi P et al. High CD34(+) cell counts decrease hematologic toxicity of autologous peripheral blood progenitor cell transplantation. Blood 1998; 91: 3148–3155.

    CAS  PubMed  Google Scholar 

  6. Desikan KR, Tricot G, Munshi NC, Anaissie E, Spoon D, Fassas A et al. Preceding chemotherapy, tumour load and age influence engraftment in multiple myeloma patients mobilized with granulocyte colony-stimulating factor alone. Br J Haematol 2001; 112: 242–247.

    Article  CAS  PubMed  Google Scholar 

  7. Marit G, Thiessard F, Faberes C, Cony-Makhoul P, Boiron JM, Bernard P et al. Factors affecting both peripheral blood progenitor cell mobilization and hematopoietic recovery following autologous blood progenitor cell transplantation in multiple myeloma patients: a monocentric study. Leukemia 1998; 12: 1447–1456.

    Article  CAS  PubMed  Google Scholar 

  8. Kotasek D, Shepherd KM, Sage RE, Dale BM, Norman JE, Gregg A et al. Factors affecting blood stem cell collections following high-dose cyclophosphamide mobilization in lymphoma, myeloma and solid tumors. Bone Marrow Transplant 1992; 9: 11–17.

    CAS  PubMed  Google Scholar 

  9. To LB, Shepperd KM, Haylock DN, Dyson PG, Charles P, Thorp DL et al. Single high doses of cyclophosphamide enable the collection of high numbers of hemopoietic stem cells from the peripheral blood. Exp Hematol 1990; 18: 442–447.

    CAS  PubMed  Google Scholar 

  10. Fitoussi O, Perreau V, Boiron JM, Bouzigon E, Cony-Makhoul P, Pigneux A et al. A comparison of toxicity following two different doses of cyclophosphamide for mobilization of peripheral blood progenitor cells in 116 multiple myeloma patients. Bone Marrow Transplant 2001; 27: 837–842.

    Article  CAS  PubMed  Google Scholar 

  11. Lefrere F, Makke J, Fermand J, Marolleau JP, Dal Cortivo L, Alberti C et al. Blood stem cell collection using chemotherapy with or without systematic G-CSF: experience in 52 patients with multiple myeloma. Bone Marrow Transplant 1999; 24: 463–466.

    Article  CAS  PubMed  Google Scholar 

  12. Barlogie B, Smith L, Alexanian R . Effective treatment of advanced multiple myeloma refractory to alkylating agents. N Engl J Med 1984; 310: 1353–1356.

    Article  CAS  PubMed  Google Scholar 

  13. Collin R, Greaves M, Preston FE . Potential value of vintristine–adriamycin–dexamethasone combination chemotherapy (VAD) in refractory and rapidly progressive myeloma. Eur J Haematol 1987; 39: 203–208.

    Article  CAS  PubMed  Google Scholar 

  14. Goldschmidt H, Hegenbart U, Haas R, Hunstein W . Mobilization of peripheral blood progenitor cells with high-dose cyclophosphamide (4 or 7 g/m2) and granulocyte colony-stimulating factor in patients with multiple myeloma. Bone Marrow Transplant 1996; 17: 691–697.

    CAS  PubMed  Google Scholar 

  15. Jantunen E, Putkonen M, Nousiainen T, Pelliniemi TT, Mahlamaki E, Remes K . Low-dose or intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor for progenitor cell mobilisation in patients with multiple myeloma. Bone Marrow Transplant 2003; 31: 347–351.

    Article  CAS  PubMed  Google Scholar 

  16. Lerro KA, Medoff E, Wu Y, Seropian SE, Snyder E, Krause D et al. A simplified approach to stem cell mobilization in multiple myeloma patients not previously treated with alkylating agents. Bone Marrow Transplant 2003; 32: 1113–1117.

    Article  CAS  PubMed  Google Scholar 

  17. Bellido M, Sureda A, Martino R, Madoz P, Garcia J, Brunet S . Collection of peripheral blood progenitor cells for autografting with low-dose cyclophosphamide plus granulocyte colony-stimulating factor. Haematologica 1998; 83: 428–431.

    CAS  PubMed  Google Scholar 

  18. Corso A, Arcaini L, Caberlon S, Zappasodi P, Mangiacavalli S, Lorenzi A et al. A combination of dexamethasone, cyclophosphamide, etoposide, and cisplatin is less toxic and more effective than high-dose cyclophosphamide for peripheral stem cell mobilization in multiple myeloma. Haematologica 2002; 87: 1041–1045.

    CAS  PubMed  Google Scholar 

  19. Alegre A, Tomas JF, Martinez-Chamorro C, Gil-Fernandez JJ, Fernadez-Villalta MJ, Arranz R et al. Comparison of peripheral blood progenitor cell mobilization in patients with multiple myeloma: high-dose cyclophosphamide plus GM-CSF vs G-CSF alone. Bone Marrow Transplant 1997; 20: 211–217.

    Article  CAS  PubMed  Google Scholar 

  20. Desikan KR, Barlogie B, Jagannath S, Vesole DH, Siegel D, Fassas A et al. Comparable engraftment kinetics following peripheral-blood stem-cell infusion mobilized with granulocyte colony-stimulating factor with or without cyclophosphamide in multiple myeloma. J Clin Oncol 1998; 16: 1547–1553.

    Article  CAS  PubMed  Google Scholar 

  21. Karanth M, Chakrabarti S, Lovell RA, Harvey C, Holder K, McConkey CC et al. A randomised study comparing peripheral blood progenitor mobilisation using intermediate-dose cyclophosphamide plus lenograstim with lenograstim alone. Bone Marrow Transplant 2004; 34: 399–403.

    Article  CAS  PubMed  Google Scholar 

  22. Stewart AK, Vescio R, Schiller G, Ballester O, Noga S, Rugo H et al. Purging of autologous peripheral-blood stem cells using CD34 selection does not improve overall or progression-free survival after high-dose chemotherapy for multiple myeloma: results of a multicenter randomized controlled trial. J Clin Oncol 2001; 19: 3771–3779.

    Article  CAS  PubMed  Google Scholar 

  23. Patriarca F, Damiani D, Fanin R, Grimaz S, Geromin A, Cerno M et al. High-dose therapy in multiple myeloma: effect of positive selection of CD34+ peripheral blood stem cells on hematologic engraftment and clinical outcome. Haematologica 2000; 85: 269–274.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge Sandrine Beaudier, Karina Lejnef and Robert Lemoine for the technical assistance.

Author information

Authors and Affiliations

  1. Service de Biothérapies, Hôpital Necker, AP-HP, Paris, France

    F Lefrère, F Audat, N Maillard, J A Ribeil, M Cavazzana-Calvo & L Dal Cortivo

  2. Département de Biostatistique et Informatique Médicale, U717 INSERM, Hôpital Saint-Louis, Paris, France

    S Zohar & B Varet

  3. Service d’Hématologie Adultes, Hôpital Necker, AP-HP, Paris, France

    D Ghez, R Delarue, F Suarez, O Hermine & G Damaj

  4. Service d’Onco-Hématologie, Hôpital André Mignot, Saint-Germain-en-Laye, France

    M Azagury & R Misbahi

  5. Service de Médecine Interne, Hôpital Ambroise Pare, AP-HP, Boulogne, France

    K Jondeau

Authors
  1. F Lefrère
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Zohar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Ghez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Delarue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Audat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F Suarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. O Hermine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G Damaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N Maillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J A Ribeil
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M Azagury
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. R Misbahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. K Jondeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. M Cavazzana-Calvo
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. L Dal Cortivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. B Varet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F Lefrère.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lefrère, F., Zohar, S., Ghez, D. et al. The VAD chemotherapy regimen plus a G-CSF dose of 10 μg/kg is as effective and less toxic than high-dose cyclophosphamide plus a G-CSF dose of 5 μg/kg for progenitor cell mobilization: results from a monocentric study of 82 patients. Bone Marrow Transplant 37, 725–729 (2006). https://doi.org/10.1038/sj.bmt.1705308

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705308

Keywords

Search

Advanced search

Quick links