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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 54; no. 7; pp. 1107 - 1114
• Main Authors: Jelinek, Tomas, Adamusova, Lucie, Popkova, Tereza, Tvrda, Ivana, Smejkalova, Jana, Simicek, Michal, Salounova, Dana, Kascak, Michal, Mihalyova, Jana, Plonkova, Hana, Duras, Juraj, Navratil, Milan, Hajek, Roman, Koristek, Zdenek
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-07-2019; Nature Publishing Group
• Subjects: 13/100; 13/31; 692/699/1541/1990/804; 692/699/67/1990/804; Apheresis; Bone marrow; CD34 antigen; Cell Biology; Colony-stimulating factor; Comparative analysis; Cyclophosphamide; Cytarabine; Dosage and administration; Drug therapy; Granulocyte colony-stimulating factor; Hematology; Hematopoietic stem cells; Internal Medicine; Leukocytes (granulocytic); Medicine; Medicine & Public Health; Multiple myeloma; Public Health; Stem cell transplantation; Stem Cells; Thrombocytopenia; Toxicity
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-018-0396-x

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 × 10
6
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 × 10
6
vs. 10.4 × 10
6
/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.