Abstract
Introduction
Induction treatment followed by autologous stem cell transplantation (ASCT) has been
accepted as the standard treatment for multiple myeloma (MM) patients. Granulocyte
colony stimulating agent (G-CSF), chemotherapy or agents likes plerixafor are being
used for the mobilization of stem cells from bone marrow. In this study, we evaluated
the impact of the mobilization methods on the outcome of MM patients after ASCT.
Method
The data of 205 MM patients who underwent ASCT at our center between December 2009
and January 2019 were retrospectively analyzed. Patients were divided into 2 groups
as good mobilizers (patients who were mobilized with G-CSF alone) and poor mobilizers
(patients who were failed to mobilize with G-CSF alone and mobilized with G-CSF + cylophosphomide
or G-CSF + plerixafor).
Results
The median progression free survival (PFS) was 18.27 ± 3.22 months in good mobilizers
and 14.22 ± 3.7 months in poor mobilizers. In G-CSF + cyclophosphamide method median
PFS was 15.4 ± 4.9 months wheras it was only 4 months in G-CSF + plerixafor method.
We did not find a statistically significant difference between good and poor mobilizers
regarding median PFS (p: 0.342). The median overall survival (OS) was found 34.48 ± 4.2
months in good mobilizers and 15.13 ± 5.78 months in poor mobilizers. In G-CSF + cyclophosphamide
method median OS was 17 ± 14.01 months wheras it was 10.66 ± 7.68 months in G-CSF + plerixafor
method. We found a statistically significant difference between good and poor mobilizers
regarding median OS (p: 0.007*).
Conclusion
Our study shows that difficulty in stem cell mobilization is correlated with worse
outcome.
Keywords
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References
- A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome.N Engl J Med. 1996; 335: 91-97
- High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma.N Engl J Med. 2003; 348: 1875-1883
- Autologous transplantation and maintenance therapy in multiple myeloma.N Engl J Med. 2014; 371: 895-905
- Chemotherapy plus lenalidomide versus autologous transplantation, followed by lenalidomide plus prednisone versus lenalidomide maintenance, in patients with multiple myeloma: a randomised, multicentre, phase 3 trial.Lancet Oncol. 2015; 16: 1617-1629
- Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma.N Engl J Med. 2017; 376: 1311-1320
- Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis.Leukemia. 2017; 31: 1727-1734
- Hematopoietic stem and progenitor cells: their mobilization and homing to bone marrow and peripheral tissue.Immunol Res. 2009; 44: 160-168
- Mobilization and collection of peripheral blood progenitor cells for transplantation.Transfus Apher Sci. 2005; 32: 63-72
- Improving stem cell mobilization strategies: future directions.Bone Marrow Transplant. 2009; 43: 181-195
- Mobilization of hematopoieticstem/progenitor cells: general principles and molecular mechanisms.Methods Mol Biol. 2012; 904: 1-14
- The biology and clinical uses of blood stem cells.Blood. 1997; 89: 2233-2258
- Regulatory systems in bone marrow for hematopoietic stem/progenitor cells mobilization and homing.Biomed Res Int. 2013; 2013312656
- New insights in the mobilization of hematopoietic stem cells in lymphoma and multiple myeloma patients.Biomed Res Int. 2014; 2014835138
- The AMD3100 story: the path to the discovery of a stem cell mobilizer (Mozobil).Biochem Pharmacol. 2009; 77: 1655-1664
- FDA review summary: mozobil in combination with granulocyte colony-timulating factor to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation.Oncology. 2010; 78: 282-288
- Cyclophosphamide mobilization does not improve outcome in patients receiving stem cell transplantation for multiple myeloma.Clin Lymphoma Myeloma. 2006; 6: 384-388
- Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma.Blood. 2009; 113: 5720-5726
- Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma.Blood. 2001; 98: 579-585
- Successful mobilization of PBSCs predicts favorable outcomes in multiple myeloma patients treated with novel agents and autologous transplantation.Bone Marrow Transpl. 2015; 50: 673-678
- Results from a multicenter, noninterventional registry study for multiple myeloma patients who received stem cell mobilization regimens with and without plerixafor.Bone Marrow Transplant. 2019; https://doi.org/10.1038/s41409-019-0676-0
- Poor peripheral blood stem cell mobilization affects long-term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation.J Clin Apher. 2017; : 1-9
- International uniform response criteria for multiple myeloma.Leukemia. 2006; 20: 1467-1473
- Definition of myeloid engraftment after allogeneic hematopoietic stem cell transplantation.Haematologica. 2004; 89: 763-764
- Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations.Biol Blood Marrow Transplant. 2014; 20: 295-308
- Randomized comparison of granulocyte colony-stimulating factor versus granulocyte macrophage colony-stimulating factor plus intensive chemotherapy for peripheral blood stem cell mobilization and autologous transplantation in multiple myeloma.Biol Blood MarrowTransplant. 2004; 10: 395-404
- Mobilization strategies inhard-to-mobilize patients with lymphoid malignancies.Eur J Haematol. 2010; 85: 463-471
- Association between mobilization regimen and progression-free survival after autologous stem cell transplantation for multiple myeloma.Bone Marrow Transplant. 2014; 49: 1439-1441
- Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin’s lymphoma.J Clin Oncol. 2009; 27: 4767-4773
- Plerixafor and granulocyte colony-stimulating factor for first-line steady-state autologous peripheral blood stem cell mobilization in lymphoma and multiple myeloma: results of the prospective PREDICT trial.Haematologica. 2013; 98
- Mechanisms of regulation of CXCR4/ SDF-1 (CXCL12)-dependent migration and homing in multiple myeloma.Blood. 2007; 109: 2708-2717
Article info
Publication history
Published online: January 09, 2020
Accepted:
December 30,
2019
Received in revised form:
December 16,
2019
Received:
November 3,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
