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Cytarabine + G-CSF is more effective than cyclophosphamide + G-CSF as a stem cell mobilization regimen in multiple myeloma

Bone Marrow Transplantation volume 54, pages 1107–1114 (2019)Cite this article

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Abstract

Cyclophosphamide (Cy) plus granulocyte-colony stimulating factor (G-CSF) is currently a standard regimen for hematopoietic stem cell (HSC) mobilization in patients with multiple myeloma (MM). However, cytarabine (AraC) in intermediate doses plus G-CSF seems to have a higher mobilization efficacy. The aim of this study was to retrospectively compare mobilization using AraC and Cy. Thirty consecutive MM patients were mobilized by Cy + G-CSF, and the subsequent 40 patients by AraC + G-CSF. Both groups were comparable. The target yield of 10 × 106 CD34+ cells/kg (for tandem and 2 additional transplantations) was achieved in 98% (AraC) and 57% (Cy) of patients (p < 0.0001) by 1.2 and 2.1 apheresis (means), and by single apheresis in 83 and 17% of patients, respectively. AraC mobilization resulted in higher peak concentration of CD34+ cells in blood (median 238.0 vs. 87.9/µL, p < 0.0001) and higher CD34+ yield (median 28.6 × 106 vs. 10.4 × 106/kg, p < 0.0001) compared to Cy mobilization. Toxicities were comparable except for thrombocytopenia gr. 4, observed in 50% of patients after AraC (Cy 7%). In view of these results, we conclude that mobilization with AraC plus G-CSF is very effective with acceptable toxicity and could be considered in MM patients with planned or expected higher numbers of transplantations.

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Acknowledgements

The authors want to give special thanks to Shira Timilsina Godfrey, MD for English language editing. This work was supported by the Institutional Development Plan of University of Ostrava, financial resources are allocated by The Ministry of Education, Youth and Sports (project no. IRP03_2018-2020) and by MH CZ - DRO (FNOs/2018) and also by financial support from the project ´´Cell Coolab Ostrava – Research and Development Center for Cell Therapy in Hematology and Oncology´´ (No.C.Z.02.1.01/0.0/0.0/17_049/0008440) financially supported from ERDF.

Author contributions

TJ and LA wrote the manuscript; ZK, RH, TJ, and LA designed this study; TJ and DS performed statistical analysis; ZK and RH revised the manuscript. All authors edited and approved the manuscript. The authors take full responsibility for the content of the paper.

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  1. These authors contributed equally: Tomas Jelinek, Lucie Adamusova.

Authors and Affiliations

  1. Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic

    Tomas Jelinek, Lucie Adamusova, Tereza Popkova, Ivana Tvrda, Jana Smejkalova, Michal Simicek, Dana Salounova, Michal Kascak, Jana Mihalyova, Hana Plonkova, Juraj Duras, Milan Navratil, Roman Hajek & Zdenek Koristek

  2. Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

    Tomas Jelinek, Michal Simicek, Michal Kascak, Jana Mihalyova, Juraj Duras, Milan Navratil, Roman Hajek & Zdenek Koristek

  3. Faculty of Science, University of Ostrava, Ostrava, Czech Republic

    Tomas Jelinek & Lucie Adamusova

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Jelinek, T., Adamusova, L., Popkova, T. et al. Cytarabine + G-CSF is more effective than cyclophosphamide + G-CSF as a stem cell mobilization regimen in multiple myeloma. Bone Marrow Transplant 54, 1107–1114 (2019). https://doi.org/10.1038/s41409-018-0396-x

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