Contributions
Abstract: PB2207
Type: Publication Only
Background
Induction therapy with novel agents followed by autologous stem cell transplantation (ASTC) is the worldwide gold standard for frontline treatment of younger patients with multiple myeloma (MM). Notwithstanding, a variable proportion of these patients fail to mobilize CD34+ peripheral blood stem cells (PBSC) at all or to collect an adequate number for a safe ASTC or sufficient for tandem or savage procedures (“poor mobilizer”)
Aims
The use of lenalidomide and hematological toxicity developed during induction were taken into account as possible factors associated with poor mobilization. The use of Plerixafor with G-CSF for PBSC mobilization significantly improves the chances of a successful mobilization.
Methods
We report the unicentric experience of the Department of Cellular Biotechnologies and Hematology, “Sapienza” University, Rome in 48 patients (pts) with newly diagnosed MM treated as induction therapy with Bortezomib, Thalidomide, dexamethasone (VTd; 33 pts 68,7%) or Carfilzomib, Lenalidomide-dexamethasone (KRd; 15 pts 31,3%). The median age was 55,4 years (range 48 - 61), 28 men (58,3%) and 20 women (41,7%). In all cases the mobilizing regimen was cyclophosphamide (3 g/m2) associated to G-CSF (10 mcg/Kg). International Staging System (ISS) was I -II -III in 25 (52,1%), 19 (39,6%) and 4 (8,3%) patients respectively.After induction, 7 pts (14,6%) achieved complete response (CR), 27 pts (56,3%) achieved a very good partial response (VGPR), and 14 (29,2%) partial response (PR). Filgrastim was used as G-CSF in 38 pts (79,2%) and Lenograstim in 10 pts (20,8%). The use of Plerixafor was necessary in 7 cases (46,7%) for patients treated with KRD induction regimen, in 3 cases (9 %) for VTD.
Results
The use of Plerixafor (yes or not) has been compared with the following variables: sex, age, ISS, type of G-CSF, Induction Regimen, type of monoclonal component, time between mobilization date and therapy end. In univariate analysis type of induction regimen was the only statistically significant factor (KRd 7 cases used Plerixafor vs 3 VTd); p= 0.003. CD34+ cell median final collection (x 106 /Kg ) was 8,60 x 106 /Kg (range 4.40-17) for KRd and 10,38 x 106 /Kg (range 1.49-18.8) for VTd respectively; the difference is statistically significant, p=0,047.
Conclusion
Our data though revealing a possible negative effect of lenalidomide-based regimens on PBSC mobilization used also with carfilzomib association. Lenalidomide is myelosuppressive and alters the stromal milieu thereby suppressing stem cell mobilization. Plerixafor with G-CSF has been shown to improve successful stem cell mobilization rates in patients receiving Lenalidmide based induction therapy.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Multiple Myeloma, Proteasome inhibitor
Abstract: PB2207
Type: Publication Only
Background
Induction therapy with novel agents followed by autologous stem cell transplantation (ASTC) is the worldwide gold standard for frontline treatment of younger patients with multiple myeloma (MM). Notwithstanding, a variable proportion of these patients fail to mobilize CD34+ peripheral blood stem cells (PBSC) at all or to collect an adequate number for a safe ASTC or sufficient for tandem or savage procedures (“poor mobilizer”)
Aims
The use of lenalidomide and hematological toxicity developed during induction were taken into account as possible factors associated with poor mobilization. The use of Plerixafor with G-CSF for PBSC mobilization significantly improves the chances of a successful mobilization.
Methods
We report the unicentric experience of the Department of Cellular Biotechnologies and Hematology, “Sapienza” University, Rome in 48 patients (pts) with newly diagnosed MM treated as induction therapy with Bortezomib, Thalidomide, dexamethasone (VTd; 33 pts 68,7%) or Carfilzomib, Lenalidomide-dexamethasone (KRd; 15 pts 31,3%). The median age was 55,4 years (range 48 - 61), 28 men (58,3%) and 20 women (41,7%). In all cases the mobilizing regimen was cyclophosphamide (3 g/m2) associated to G-CSF (10 mcg/Kg). International Staging System (ISS) was I -II -III in 25 (52,1%), 19 (39,6%) and 4 (8,3%) patients respectively.After induction, 7 pts (14,6%) achieved complete response (CR), 27 pts (56,3%) achieved a very good partial response (VGPR), and 14 (29,2%) partial response (PR). Filgrastim was used as G-CSF in 38 pts (79,2%) and Lenograstim in 10 pts (20,8%). The use of Plerixafor was necessary in 7 cases (46,7%) for patients treated with KRD induction regimen, in 3 cases (9 %) for VTD.
Results
The use of Plerixafor (yes or not) has been compared with the following variables: sex, age, ISS, type of G-CSF, Induction Regimen, type of monoclonal component, time between mobilization date and therapy end. In univariate analysis type of induction regimen was the only statistically significant factor (KRd 7 cases used Plerixafor vs 3 VTd); p= 0.003. CD34+ cell median final collection (x 106 /Kg ) was 8,60 x 106 /Kg (range 4.40-17) for KRd and 10,38 x 106 /Kg (range 1.49-18.8) for VTd respectively; the difference is statistically significant, p=0,047.
Conclusion
Our data though revealing a possible negative effect of lenalidomide-based regimens on PBSC mobilization used also with carfilzomib association. Lenalidomide is myelosuppressive and alters the stromal milieu thereby suppressing stem cell mobilization. Plerixafor with G-CSF has been shown to improve successful stem cell mobilization rates in patients receiving Lenalidmide based induction therapy.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Mobilization, Multiple Myeloma, Proteasome inhibitor