Chemomobilization for Stem Cell Transplantation in Patients With Multiple Myeloma
Posted: Tuesday, September 7, 2021
Chemotherapy may enhance the mobilization of stem cells without negatively impacting post-autologous stem cell transplant (ASCT) responses for patients with recently diagnosed multiple myeloma and poor responses to novel induction agents, according to Morie A. Gertz, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues. The findings of this study were published in the journal Transplantation and Cellular Therapy.
“Our data demonstrate that in multiple myeloma, patients eligible for ASCT [who] are ‘poor responders’ to induction, chemomobilization with G-CSF or G-CSF and ‘on-demand’ plerixafor is safe and is associated with high yield stem cell collection and is a valid inexpensive mobilization technique,” stated the study investigators.
Patients with newly diagnosed multiple myeloma treated at the Mayo Clinic who exhibited poor responses to induction agents were mobilized via intermediate chemotherapy, G-CSF (granulocyte colony-stimulating factor), and “on-demand” use of the hematopoietic stem cell mobilizer plerixafor (n = 117). A second cohort (n = 117), matched to the first by pretransplant evaluation, were mobilized with G-CSF and plerixafor but did not receive chemotherapy. Collection of stem cells began when levels of CD34+ reached 10 cells/mL, and plerixafor was administered when the WBC count was higher than 1,000 cells/mL.
Patients who received chemomobilization appeared to have higher levels of stem cell yields (median = 10.7 x 106 cells/kg) than the nonchemotherapy cohort (median = 8.77 x 106 cells/kg; P < .001). The first and second cohorts did not differ in the length of hospitalization during stem cell transplantation (P = .95), days to neutrophil engraftment (P = .22) and platelet engraftment (P = .27), or risk of bacteremia (P = .52), suggesting the treatments were equally tolerated. Patients who did not receive chemotherapy were found to be more than two times likely to require plerixafor for mobilization than were the chemomobilized group (65% vs. 29%, respectively, P < .001).
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.