TY - JOUR
T1 - The Efficacy and Safety of Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma Patients Who Are Poor Responders to Induction
T2 - The Mayo Clinic Experience
AU - Vaxman, Iuliana
AU - Muchtar, Eli
AU - Jacob, Eapen
AU - Kapoor, Prashant
AU - Kumar, Shaji
AU - Dispenzieri, Angela
AU - Buadi, Francis
AU - Dingli, David
AU - Gonsalves, Wilson
AU - Kourelis, Taxiarchis
AU - Warsame, Rahma
AU - Lacy, Martha
AU - Hogan, William
AU - Gertz, Morie A.
N1 - Publisher Copyright:
© 2021 The American Society for Transplantation and Cellular Therapy
PY - 2021/9
Y1 - 2021/9
N2 - We report the outcomes of 117 patients with newly diagnosed multiple myeloma who received novel agent induction, had a poor response to induction, and were mobilized using intravenous intermediate-dose cyclophosphamide (82%) or VD-PACE (18%) plus granulocyte colony-stimulating factor (G-CSF) and on-demand plerixafor. The median progression-free survival and overall survival of the chemo-mobilized cohort were 21 months (95% confidence interval [CI], 15–71) and 58 months (95% CI, 47–80), respectively. We compared our cohort to a 117-patient cohort matched by the level of response at pretransplant evaluation. The matched patients were mobilized with G-CSF and on-demand plerixafor without chemotherapy. Patients receiving chemo-mobilization had higher stem cell yields than the growth-factor-only cohort (median, 10.7 × 106 cells/kg vs. 8.77 × 106 cells/kg, respectively; P <.001). The safety profile of chemo-mobilization was favorable, and there was no difference between the two groups in length of hospitalization during autologous stem cell transplantation (P =.95), days to neutrophil engraftment (P =.22), days to platelet engraftment (P =.27), or risk of bacteremia (P =.52). Twenty-nine percent of the chemo-mobilized cohort and 65% of the matched cohort required plerixafor for adequate mobilization (P <.001). Chemo-mobilization enhances stem cell collection without adversely impacting the post-transplant clinical course.
AB - We report the outcomes of 117 patients with newly diagnosed multiple myeloma who received novel agent induction, had a poor response to induction, and were mobilized using intravenous intermediate-dose cyclophosphamide (82%) or VD-PACE (18%) plus granulocyte colony-stimulating factor (G-CSF) and on-demand plerixafor. The median progression-free survival and overall survival of the chemo-mobilized cohort were 21 months (95% confidence interval [CI], 15–71) and 58 months (95% CI, 47–80), respectively. We compared our cohort to a 117-patient cohort matched by the level of response at pretransplant evaluation. The matched patients were mobilized with G-CSF and on-demand plerixafor without chemotherapy. Patients receiving chemo-mobilization had higher stem cell yields than the growth-factor-only cohort (median, 10.7 × 106 cells/kg vs. 8.77 × 106 cells/kg, respectively; P <.001). The safety profile of chemo-mobilization was favorable, and there was no difference between the two groups in length of hospitalization during autologous stem cell transplantation (P =.95), days to neutrophil engraftment (P =.22), days to platelet engraftment (P =.27), or risk of bacteremia (P =.52). Twenty-nine percent of the chemo-mobilized cohort and 65% of the matched cohort required plerixafor for adequate mobilization (P <.001). Chemo-mobilization enhances stem cell collection without adversely impacting the post-transplant clinical course.
KW - Autologous stem cell transplantation
KW - Chemo-mobilization
KW - Cyclophosphamide
KW - Mobilization
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UR - http://www.scopus.com/inward/citedby.url?scp=85110521430&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2021.06.016
DO - 10.1016/j.jtct.2021.06.016
M3 - Article
C2 - 34153504
AN - SCOPUS:85110521430
SN - 2666-6367
VL - 27
SP - 770.e1-770.e7
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 9
ER -