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Reply to ‘Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients’

Leukemia volume 22, pages 1281–1282 (2008)Cite this article

We would like to commend Professor Mazumder et al.1 for presenting additional data that confirm our initial observation of decreased stem mobilization following the use of lenalidomide-based therapies for newly diagnosed myeloma.2 The rate of peripheral blood stem cell collection failure in this report is higher than what we have observed in our analysis of all patients with myeloma undergoing an attempt at stem collection. To some extent, this probably reflects the total number of apheresis that the patients were subjected to. The median number of collections from patients who had prior lenalidomide was five in our study compared to three in the current report. Also, it is not clear whether every patient who received lenalidomide-based initial therapy, who came to stem collection at the three institutions, were included in the study. Irrespective of the differences in the two studies, both convey the same message. Physicians and patients should be aware of the potential for mobilization failures when lenalidomide is used for initial therapy. Whether this is a function of one or more of the factors such as older age, longer duration of therapy or interval from the last dose of lenalidomide to initiation of growth factors needs to be further studied in this patient group. Clearly, use of chemotherapy for mobilization is an option in these patients. It is unclear whether we need to adopt this for all the patients, or only use this for rescue in case of initial failure. A longer rest period off lenalidomide (approximately 4 weeks) prior to stem cell mobilization may be helpful, and we have initiated this change at our institution. We believe that once mobilizing agents such as AMD-3100 become available, this issue will be resolved to a large extent.

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References

  1. Mazumder A, Kaufmann J, Niesvizky R, Lonial S, Vesole D, Jagannath S . Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients. Leukemia (in press).

  2. Kumar S, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Gastineau DA et al. Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia 2007; 21: 2035–2042.

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  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    S Kumar & M A Gertz

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  1. S Kumar
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  2. M A Gertz
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Correspondence to S Kumar.

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Kumar, S., Gertz, M. Reply to ‘Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients’. Leukemia 22, 1281–1282 (2008). https://doi.org/10.1038/sj.leu.2405036

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