Intermediate-dose CY and G-CSF more efficiently mobilize adequate numbers of PBSC for tandem autologous PBSC transplantation compared with low-dose CY in patients with multiple myeloma

• Published in: Cytotherapy (Oxford, England) Vol. 9; no. 6; pp. 539 - 547
• Main Authors: Hiwase, D.K, Bollard, G, Hiwase, S, Bailey, M, Muirhead, J, Schwarer, A.P
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2007; Informa UK Ltd
• Subjects: Adult; Advanced Basic Science; Aged; Antigens, CD34 - metabolism; Cell Count; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - pharmacology; Demography; Dose-Response Relationship, Drug; Female; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - pharmacology; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cells - cytology; Hematopoietic Stem Cells - drug effects; Humans; Male; Middle Aged; multiple myeloma; Multiple Myeloma - surgery; Other; Peripheral Blood Stem Cell Transplantation; Retrospective Studies; stem cell mobilization; Transplantation, Autologous; stem cell mobilization; Cyclophosphamide; multiple myeloma
• ISSN: 1465-3249; 1477-2566
• DOI: 10.1080/14653240701452800

Background Autologous PBSC transplantation is the standard care for patients with multiple myeloma. The most common regimen used to mobilize PBSC consists of CY and G-CSF. Methods We retrospectively analyzed the efficacy and toxicity of two regimens of CY for PBSC mobilization: low-dose CY (1–2 g/m2 , LD-CY, n = 61) plus G-CSF, and intermediate-dose CY (3–4 g/m2 , ID-CY, n = 26) plus G-CSF. Results In the LD-CY group, 5.17 (0.23–17.3)×106 CD34+ cells/kg, and in the ID-CY group 7.71 (0.08–26.4)×106 CD34+ cells/kg ( P = 0.018), were collected. Although ≥2 × 106 /kg CD34+ cells were collected in 89% of the LD-CY group and 92% of the ID-CY group, this was achieved after a single leukapheresis in 54% of the LD-CY group and 92% of the ID-CY group ( P = 0.0001). Patients who are to have tandem autologous PBSC transplants require ≥4 × 106 /kg CD34+ cells. This was achieved in only 65% patients in the LD-CY group but 88% in the ID-CY group ( P = 0.05). Among patients who had not had prior melphalan and/or >12 months of prior treatment, 74% in the LD-CY group and 100% in ID-CY group mobilized ≥4x106 /kg CD34+ cells. Febrile neutropenia was more frequent in the ID-CY group (38% vs. 13%). Discussion In conclusion, compared with LD-CY, patients receiving ID-CY were more likely to collect a total CD34+ cell number adequate for tandem autologous PBSC transplantation. The increased toxicity was manageable and considered acceptable.