Autologous stem-cell collection following VTD or VRD induction therapy in multiple myeloma: a single-center experience

Abstract

Triplet-drug regimen bortezomib–thalidomide–dexamethasone (VTD) and bortezomib–lenalidomide–dexamethasone (VRD) are considered as standard of care induction prior autologous stem-cell transplantation (ASCT) in myeloma. In addition to improve response rate, induction therapy should preserve an adequate stem-cell collection. In the present retrospective study, we analyzed stem-cell collection in 325 newly diagnosed myeloma patients who received either VTD or VRD induction before ASCT. Stem-cell mobilization consisted of intravenous cyclophosphamide plus G-CSF. Plerixafor was administered preemptively to rescue mobilization. In comparison with VTD, VRD induction was associated with a more frequent use of plerixafor (19.3% versus 5.4%, p = 0.004) and with an increased number of apheresis to reach adequate collection (>2 apheresis required in 42.3% versus 30.2%, p = 0.05). Moreover, more patients experienced collection failure in the VRD group (6% versus 1.8%, p = 0.004). The median number of CD34-positive cells (×106/kg) was lower in the VRD group: 8.5 versus 9.3 (p = 0.05) in the VTD group. The vast majority of patients underwent ASCT (93% versus 98%, in VRD and VTD group, respectively). These data highlight the need of optimal stem-cell collection strategy, especially in the context of tandem transplantation and incorporation of anti-CD38 monoclonal antibody into induction.

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Fig. 1: Impact of VTD or VRD induction on stem-cell collection.

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Acknowledgements

CT, PM, and SLG, are members of Site de Recherche Intégrée sur le Cancer (SIRIC) ILIAD, (INCA-DGOS-Inserm_12558).

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VL, CF, and CT, designed the study. VL, CF, CA, and CT, collected data. BT, performed statistical analysis. PD, performed stem-cell harvesting. CT, and VL, wrote the manuscript. All authors treated patients and critically reviewed the manuscript, and gave final approval.

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Correspondence to Cyrille Touzeau.

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CT and PM are advisory board member and received honoraria from Sanofi.

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Laurent, V., Fronteau, C., Antier, C. et al. Autologous stem-cell collection following VTD or VRD induction therapy in multiple myeloma: a single-center experience. Bone Marrow Transplant (2020). https://doi.org/10.1038/s41409-020-01033-8

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