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Plasma Cell Disorders

Peripheral blood stem cell mobilization in multiple myeloma comparison of two consecutive regimens in a limited resources country

Bone Marrow Transplantation volume 52, pages 222–227 (2017)Cite this article

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Abstract

This study compared retrospectively the effectiveness, toxicity and hematopoietic recovery after autologous peripheral blood stem cell transplantation (ASCT) of two consecutive peripheral blood stem cell mobilization regimens in newly diagnosed MM patients. Patients in group 1 (n=178) were treated with 4 g/m2 of cyclophosphamide (CY) plus G-CSF (5 μg/kg/day). Patients in group 2 (n=117) with 750 mg/m2 of VP16 plus G-CSF (10 μg/kg/day). Optimal mobilization, defined by a target number of 8 × 106 CD34+ cells/kg collected, was achieved in 62.4% and 89.7% of patients in groups 1 and 2, respectively (P<10−4). The median number of aphaeresis sessions was reduced from two in group 1 to one in group 2 (P<10−4). Grade4 neutropenia, febrile neutropenia and IV antibiotic use were significantly more frequent in group 1 than in group 2 (P<10−4). Red blood cell transfusion requirements were significantly greater in group 1 (P=0.007). The switch to VP16-G-CSF10 resulted in a significant reduction of the number of hospitalization days (P<10−4). Neutrophil and platelet recovery after ASCT occurred on days 11 and 12, respectively, in the two groups with no significant differences. VP16+G-CSF10 allowed liberation of resources in the clinical and aphaeresis departments and demonstrated a better effectiveness-safety profile than CY+G-CSF5.

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References

  1. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fusibet JG, Rossi JF et al. Intergroupe Francais du Myelome. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med 1996; 335: 91–97.

    Article  CAS  PubMed  Google Scholar 

  2. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  PubMed  Google Scholar 

  3. Fermand J-P, Katsahian S, Divine M, Leblond V, Dreyfus F, Macro M et al. High dose therapy and autologous blood stem-cell transplantation compared with conventional treatment in myeloma patients aged 55 to 65 years: long-term results of a randomized control trial from the Group Myelome-Autogreffe. J Clin Oncol 2005; 23: 9227–9233.

    Article  CAS  PubMed  Google Scholar 

  4. 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 

  5. Jimenez-Zepeda VH, Mikhael J, Winter A, Franke N, Masih-Khan E, Trudel S et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: Impact on progression-free and overall survival. Biol Blood Marrow Transplant 2012; 18: 773–779.

    Article  PubMed  Google Scholar 

  6. Alvares CL, Davies FE, Horton C, Patel G, Powles R, Morgan GJ . The role of second autografts in the management of myeloma at first relapse. Haematologica 2006; 91: 141–142.

    PubMed  Google Scholar 

  7. Michaelis LC, Saad A, Zhong X, Le-Rademacher J, Freytes CO, Marks DI et al. Salvage second hematopoietic cell transplantation in myeloma. Biol Blood Marrow Transplant 2013; 19: 760–766.

    Article  PubMed  Google Scholar 

  8. Barlogie B, Jagannath S, Desikan KR, Mattox S, Vesole D, Siegel D et al. Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood 1999; 93: 55–65.

    CAS  PubMed  Google Scholar 

  9. Barlogie B, Tricot GJ, van Rhee F, Angtuaco E, Walker R, Epstein J et al. Long term outcome results of the first tandem auto transplant trial for multiple myeloma. Br J Haematol 2006; 135: 158–164.

    Article  PubMed  Google Scholar 

  10. Boiron JM, Marit G, Faberes C, Cony-Makhoul P, Foures C, Ferrer AM et al. Collection of peripheral blood stem cells in multiple myeloma following single high-dose cyclophosphamide with and without recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF). Bone Marrow Transplant 1993; 12: 49–55.

    CAS  PubMed  Google Scholar 

  11. Narayanasami U, Kanteti R, Morelli J, Klekar A, Al-Olama A, Keating C et al. Randomized trial of filgrastim versus chemotherapy and filgrastim mobilization of hematopoietic progenitor cells for rescue in autologous transplantation. Blood 2001; 98: 2059–2064.

    Article  CAS  PubMed  Google Scholar 

  12. Alegre A, Tomes JF, Martinez-Charmorro C, Gil-Fernández JJ, Fernández-Villalta M J, 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. Bone Marrow Transplant 1997; 20: 211–217.

    Article  CAS  PubMed  Google Scholar 

  13. Arora M, Burns LJ, Barker JN, Miller JS, Defor TE, Olujohungbe AB et al. Randomized comparison of granulocyte colony –stimulating factor versus granulocyte-macrophage colony- stimulating factor plus intensive chemotherapy for peripheral blood stem cell mobilization and autologous transplantation in multiple myeloma. Biol Blood Marrow Transplant 2004; 10: 395–404.

    Article  CAS  PubMed  Google Scholar 

  14. DiPersio JF, Stadtmauer EA, Nademanee A, Micallef INM, Stiff PJ, Kaufman JL et al. Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma. Blood 2009; 113: 5720–5726.

    CAS  PubMed  Google Scholar 

  15. Kumar S, Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W et al. Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-lenalidomide-, or bortezomib-containing regimens. Blood 2009; 114: 1729–1735.

    Article  CAS  PubMed  Google Scholar 

  16. Sutherland DR, Anderson L, Keeney M, Nayar R, Chin-Yee I . The ISHAGE guidelines for CD34+ cell determination by flow cytometry. J Hematother 1996; 5: 213–226.

    Article  CAS  PubMed  Google Scholar 

  17. Bergsagel PL, Mateos MV, Gutierrez NC, Rajkumar SV, San Miguel JF . Improving overall survival and overcoming adverse prognosis in the treatment of cytogenetically high-risk multiple myeloma. Blood 2013; 121: 884–892.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Boyd KD, Ross FM, Chiecchio L, Dagrada GP, Konn ZJ, Tapper WJ et al. A novel prognostic model in myeloma based on cosegregating adverse FISH lesions and the ISS: analysis of patients treated in the MRC Myeloma IX trial. Leukemia 2012; 26: 349–355.

    Article  CAS  PubMed  Google Scholar 

  19. Durie BGM, Harousseau J-L, Miguel JS, Bladé J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.

    Article  CAS  PubMed  Google Scholar 

  20. Li J, Hamilton E, Vaughn L, Graiser M, Renfroe H, Lechowicz MJ et al. Effectiveness and cost analysis of ‘just-in-time’ salvage plerixafor administration in autologous transplant patients with poor stem cell mobilization kinetics. Transfusion 2011; 51: 2175–2182.

    Article  PubMed  Google Scholar 

  21. Gopal AK, Karami M, Mayor J, Macebeo M, Linenberger M, Bensinger WI et al. The effective use of plerixafor as real-time rescue strategy for patients poorly mobilizing autologous CD34 cells. J Clin Apheresis 2012; 27: 81–87.

    Article  PubMed  Google Scholar 

  22. Hay AE, Lawrie A, Robinson N, Dong B, Culligan DJ . A retrospective study of autologous stem cell mobilization to guide an immediate salvage protocol using plerixafor for patients who mobilize stem cells poorly. J Clin Apheresis 2013; 28: 378–380.

    PubMed  Google Scholar 

  23. Awan F, Kochuparambil ST, Faconer DE, Campston A, Leadmon S, Watkins K et al. Comparable efficacy and lower cost of PBSC mobilization with intermediate-dose cyclophosphamide and G-CSF compared with plerixafor and G-CSF in patients with multiple myeloma treated with novel therapies. Bone Marrow Transplant 2013; 48: 1279–1284.

    Article  CAS  PubMed  Google Scholar 

  24. Afifi S, Adel NG, Devlin S, Duck E, Vanak J, Landau H et al. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study. Bone Marrow Transplant 2016; 51: 546–552.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Wood WA, Whitley J, Moore D, Sharf A, Irons R, Rao K et al. Chemomobilization with Etoposide is highly effective in patients with multiple myeloma and overcomes the effects of age and prior therapy. Biol Blood Marrow Transplant 2011; 17: 141–146.

    Article  CAS  PubMed  Google Scholar 

  26. Hamadani M, Kochuparambil ST, Osman S, Cumpston A, Leadmon S, Bunner P et al. Intermediate-dose versus low-dose cyclophosphamide and granulocyte colony-stimulating factor for peripheral blood stem cell mobilization in patients with multiple myeloma treated with novel induction therapies. Biol Blood Marrow Transplant 2012; 18: 1128–1135.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  28. Hiwase DK, Bollard G, Hiwase S, Bailey M, Muirhead J, Schwarer AP . Intermediate-dose CY and G-CSF more efficiently mobilize adequate numbers of PBSC for tandem autologous PBSC transplantation compared with low-dose CY in patients with multiple myeloma. Cytotherapy 2007; 9: 539–547.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Centre National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia

    N Ben Abdejlil, D Belloumi, R El Fatimi, L Torjman, A Lakhal, T Ben Othman & S Ladeb

  2. Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis,, Tunisia

    N Ben Abdejlil, D Belloumi, R El Fatimi, L Torjman, A Lakhal, T Ben Othman & S Ladeb

  3. Centre National de Transfusion Sanguine, Tunis,, Tunisia

    M Mâammar, F Jenhani & S Hmida

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  1. N Ben Abdejlil
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Ben Abdejlil, N., Belloumi, D., Mâammar, M. et al. Peripheral blood stem cell mobilization in multiple myeloma comparison of two consecutive regimens in a limited resources country. Bone Marrow Transplant 52, 222–227 (2017). https://doi.org/10.1038/bmt.2016.246

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  • DOI: https://doi.org/10.1038/bmt.2016.246

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