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The impact of G-CSF alone vs G-CSF and cyclophosphamide mobilisation on autograft immune cell content in multiple myeloma

Bone Marrow Transplantation volume 57, pages 1001–1003 (2022)Cite this article

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Autologous stem-cell transplantation (ASCT) remains first-line therapy for eligible myeloma patients. Mobilisation is generally performed using G-CSF alone (G-alone) or in combination with cyclophosphamide (CY), the latter leading to higher CD34+ yields [1].

Although the benefit of ASCT is primarily attributed to chemotherapy intensification, studies have identified improved early immune-reconstitution, manifest as a higher day-15 post-transplant lymphocyte count, as a critical factor favourably impacting outcomes [2]. Due to CY’s lymphotoxicity, G-alone mobilisation produces superior autograft lymphocyte yields [1, 2], including higher NK and T-cell fractions [1]. Enhanced autograft lymphocyte content is relevant because it is associated with improved immune-recovery and survival post-ASCT in myeloma [2], with NK, CD4 and CD8 T-lymphocytes most strongly linked to better outcomes [1, 3]. While immune-effector cells may enhance outcomes through tumour immunosurveillance or defence from infection, the influence of autograft immune-suppressor cells, including myeloid-derived suppressor cells (MDSC) and the PD-1/PDL-1 axis is unclear.

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Fig. 1: Survival according to autograft immune cell content.

Data availability

The dataset generated and analysed during the current study is available from the corresponding author on reasonable request.

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Acknowledgements

The authors have no specific acknowledgements.

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Authors and Affiliations

  1. Department of Clinical Haematology, Austin Health, Melbourne, VIC, Australia

    Matthew J. Rees, Andrew Grigg & Daniela Zantomio

  2. Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia

    Ashish Panigrahi & Simon J. Harrison

  3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

    Simon J. Harrison

  4. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia

    Andrew Spencer, Tiffany Khong, Simon Gibbs & Jay Hocking

  5. Department of Haematology, Eastern Health, Melbourne, VIC, Australia

    Simon Gibbs & Jay Hocking

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Contributions

MJR, AG, DZ designed the study; MJR, AP, SH, AS, TK, SG, JH, AG and DZ contributed data and reviewed the manuscript; TK performed flow cytometric analysis; MJR analysed the data; MJR wrote the manuscript, and all authors approved the manuscript.

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Correspondence to Matthew J. Rees.

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Rees, M.J., Panigrahi, A., Harrison, S.J. et al. The impact of G-CSF alone vs G-CSF and cyclophosphamide mobilisation on autograft immune cell content in multiple myeloma. Bone Marrow Transplant 57, 1001–1003 (2022). https://doi.org/10.1038/s41409-022-01647-0

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