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A randomized evaluation of vinorelbine versus gemcitabine chemotherapy mobilization of stem cells in myeloma patients

Bone Marrow Transplantation volume 55, pages 2047–2051 (2020)Cite this article

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Numerous studies have established bortezomib-based triple-induction regimens followed by high-dose melphalan chemotherapy with autologous stem cell transplantation (ASCT) as first-line treatment in fit myeloma patients [1,2,3]. Cyclophosphamide with G-CSF or G-CSF alone are most frequently used for CD34+ mobilization before ASCT in myeloma patients [3,4,5,6], but up to 20% of patients poorly mobilize following cytokines alone or together with chemotherapy [7]. The additional use of the CXCR4 antagonist plerixafor represents a rescue strategy for sufficient CD34+ mobilization.

Since two decades, alternatively, Swiss centers use a non-myelosuppressive CD34+ mobilization regimen combining vinorelbine chemotherapy with G–CSF, which is safe and effective in daily routine [8,9,10], and the rescue use of plerixafor was also investigated in this setting [10]. This non-myelosuppressive mobilization is associated with less side effects. However, with the predominant use of bortezomib during induction, more myeloma patients present with pre-existing neuropathy at CD34+ collection. A main side effect of vinorelbine, again, is neurotoxicity and, thereby, it can aggravate pre-existing neuropathy [11].

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Acknowledgements

This work was supported grant of the Swiss Cancer Research #201602–6803 (to TP). The authors wish to thank the data management, the apheresis, the flow cytometry, and the stem cell laboratory teams of the ASCT program at the University hospital of Bern and its associated partner hospitals and collaborators for documentation of data relevant for this study.

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  1. These authors contributed equally: Ulrike Bacher, Thomas Pabst

Authors and Affiliations

  1. Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Barbara Jeker, Sarah Farag, Urban Novak & Thomas Pabst

  2. Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Behrouz Mansouri Taleghani & Ulrike Bacher

  3. Department of Clinical Research, University of Bern, Bern, Switzerland

    Beatrice U. Mueller

  4. SAKK Coordinating Centre, Bern, Switzerland

    Qiyu Li

  5. Department of Oncology, Kantonsspital, Fribourg, Switzerland

    Daniel Betticher

  6. Department of Oncology, Regionalspital, Thun, Switzerland

    Jean-Marc Luethi

  7. Department of Oncology, Kantonsspital, Solothurn, Switzerland

    Simone Farese

  8. Department of Hematology, Kantonsspital, Lucerne, Switzerland

    Axel Ruefer

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  1. Barbara Jeker
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Contributions

Study design: TP; data analysis: BJ, SF, UB, BUM, TP contribution of clinical and laboratory data: UN, BMT, DB, JML, SF, AR; statistics: QL; writing of paper: BJ, UB, TP; and critical review of paper: all authors; final approval of paper: all authors.

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Correspondence to Thomas Pabst.

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Jeker, B., Farag, S., Taleghani, B.M. et al. A randomized evaluation of vinorelbine versus gemcitabine chemotherapy mobilization of stem cells in myeloma patients. Bone Marrow Transplant 55, 2047–2051 (2020). https://doi.org/10.1038/s41409-020-0875-8

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