OPTIMIZATION OF APPROACHES FOR STEM CELL MOBILIZATION FOR AUTOLOGOUS STEM CELL TRANSPLANT FOR MULTIPLE MYELOMA: PRACTICAL CONSIDERATIONS
(Abstract release date: 05/18/17)
EHA Library. Lee O. 05/18/17; 182695; PB1981
Oi-Lin Lee
Contributions
Contributions
Abstract
Abstract: PB1981
Type: Publication Only
Background
Autologous stem cell transplant (ASCT) is a well-established treatment for myeloma. However, the optimal strategy for stem cell mobilization remains undefined. The goal of mobilization is to collect adequate stem cells for at least 2 ASCT (4x106/kg), with the minimum apheresis sessions and toxicities such as febrile neutropenia.
Aims
We aim to compare stem cell mobilization using granulocyte colony stem cell factor (GCSF) only (steady state), high dose cyclophosphamide (4 g/m2) with GCSF or low dose cyclophosphamide (2 g/m2) with GCSF.
Methods
We performed a retrospective analysis of 79 patients mobilized with GCSF only from mid-2014 to Aug 2016 with 32 patients mobilized using high dose cyclophosphamide and 23 patients with low dose cyclophosphamide during a similar period.
Results
Patients undergoing steady state collection required a median of 2 days for adequate collection, in comparison to 1 day for both high and low dose cyclophosphamide. Addition of pleraxifor was required in 27.8% of patients on steady state collection, in contrast to 3.1% and 13% of patients on high and low dose cyclophosphamide respectively. The mean yield of CD34+ x 106/kg cells collected was 5.39, 9.14 and 8.5 for steady state, high and low dose. There was no significant difference in time to engraftment despite a lower dose of CD34+ cells reinfused for the steady state cohort.
Admission for febrile episodes was observed in 50% of patients mobilized with high dose cyclophosphamide, as compared to 13% of patients on the lower dose regime and none in the steady state cohort. Patients mobilized with cyclophosphamide had a longer interval between stem cell collection and transplant (median of 20, 42 and 34 days respectively for steady state, high dose and low dose). However, we observed that 60.7% patients with steady state mobilization had increases in their myeloma markers during this period, in contrast to biochemical improvement in 50% of patients mobilized with high dose cyclophosphamide and 26% with low dose cyclophosphamide.
Conclusion
All 3 strategies for stem cell mobilization have their own merit. Steady state mobilization is safe and yields sufficient stem cells; however, patients require more apheresis sessions. Moreover, more than a quarter require additional therapy with plerixafor. Of concern, greater than half of these patients have increased myeloma markers during the interval between stopping chemotherapy and mobilization which may potentially affect outcomes.
Mobilization with high dose cyclophosphamide yield more CD34+ cells but with increased toxicities- 50% of patients required admission for febrile episodes. Conversely, half of these patients had improvement in their myeloma markers. The use of low dose cyclophosphamide for mobilization resulted in lower admission rates (13%), however, pleraxifor is required in a fraction.
In light of these findings, we propose that patients who have not achieved at least VGPR should be mobilized with cyclophosphamide, the dosage dependent on their individual risks.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Mobilization, Stem cell collection
Abstract: PB1981
Type: Publication Only
Background
Autologous stem cell transplant (ASCT) is a well-established treatment for myeloma. However, the optimal strategy for stem cell mobilization remains undefined. The goal of mobilization is to collect adequate stem cells for at least 2 ASCT (4x106/kg), with the minimum apheresis sessions and toxicities such as febrile neutropenia.
Aims
We aim to compare stem cell mobilization using granulocyte colony stem cell factor (GCSF) only (steady state), high dose cyclophosphamide (4 g/m2) with GCSF or low dose cyclophosphamide (2 g/m2) with GCSF.
Methods
We performed a retrospective analysis of 79 patients mobilized with GCSF only from mid-2014 to Aug 2016 with 32 patients mobilized using high dose cyclophosphamide and 23 patients with low dose cyclophosphamide during a similar period.
Results
Patients undergoing steady state collection required a median of 2 days for adequate collection, in comparison to 1 day for both high and low dose cyclophosphamide. Addition of pleraxifor was required in 27.8% of patients on steady state collection, in contrast to 3.1% and 13% of patients on high and low dose cyclophosphamide respectively. The mean yield of CD34+ x 106/kg cells collected was 5.39, 9.14 and 8.5 for steady state, high and low dose. There was no significant difference in time to engraftment despite a lower dose of CD34+ cells reinfused for the steady state cohort.
Admission for febrile episodes was observed in 50% of patients mobilized with high dose cyclophosphamide, as compared to 13% of patients on the lower dose regime and none in the steady state cohort. Patients mobilized with cyclophosphamide had a longer interval between stem cell collection and transplant (median of 20, 42 and 34 days respectively for steady state, high dose and low dose). However, we observed that 60.7% patients with steady state mobilization had increases in their myeloma markers during this period, in contrast to biochemical improvement in 50% of patients mobilized with high dose cyclophosphamide and 26% with low dose cyclophosphamide.
Conclusion
All 3 strategies for stem cell mobilization have their own merit. Steady state mobilization is safe and yields sufficient stem cells; however, patients require more apheresis sessions. Moreover, more than a quarter require additional therapy with plerixafor. Of concern, greater than half of these patients have increased myeloma markers during the interval between stopping chemotherapy and mobilization which may potentially affect outcomes.
Mobilization with high dose cyclophosphamide yield more CD34+ cells but with increased toxicities- 50% of patients required admission for febrile episodes. Conversely, half of these patients had improvement in their myeloma markers. The use of low dose cyclophosphamide for mobilization resulted in lower admission rates (13%), however, pleraxifor is required in a fraction.
In light of these findings, we propose that patients who have not achieved at least VGPR should be mobilized with cyclophosphamide, the dosage dependent on their individual risks.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Mobilization, Stem cell collection
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