High-dose chemotherapy followed by autologous stem cell transplantation is a major component in the treatment of patients with multiple myeloma. As a prerequisite, the successful collection of a sufficient number of viable peripheral blood hematopoietic CD34+ cells is critical. A common standard protocol for mobilization is currently not defined and critically discussed especially in German-speaking Europe. In times of the Covid-19 pandemic, safe and effective strategies have to be chosen to minimize hospitalization times and severe courses.
In this single-center retrospective analysis, safety and efficacy of cyclophosphamide plus etoposide (CE) and growth-factor support (n = 33) was compared to cyclophosphamide mono treatment and growth-factor support (n = 49) in 82 patients with multiple myeloma at first diagnosis.
CE was superior to cyclophosphamide mono with a significantly higher number of collected CD34+ cells (15.46 × 106 CD34+ cells/kg vs. 9.92 × 106 CD34+ cells/kg), significantly faster engraftment of granulocytes after stem cell transplantation (day 10.5 vs. day 11.6), shorter duration of the inpatient stay (17.47 days vs. 19.16 days) and significantly less transfusions (8.82 % vs. 30.61 % patients receiving transfusions). The safety profile was comparable in both groups and in line with published data.
We conclude that CE is a safe and highly effective mobilization protocol in patients with multiple myeloma at first diagnosis and appears to be superior to the commonly used cyclophosphamide mono regimen.
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- NCCN guidelines insights: multiple myeloma, version 3.2018.J Natl Compr Canc Netw. 2018; 16: 11-20
- Meta-analysis to evaluate high-dose therapy followed by stem cell transplant in patients with multiple myeloma-reply.JAMA Oncol. 2018; 4: 1618
- Current strategies for the management of autologous peripheral blood stem cell mobilization failures in patients with multiple myeloma.J Clin Apher. 2018; 33: 357-370
- UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy.J Clin Apher. 2018; 33: 46-59
- International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100).Leukemia. 2009; 23: 1904-1912
- Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens.Blood. 2009; 114: 1729-1735
- Peripheral blood stem cell mobilization in multiple myeloma: Growth factors or chemotherapy?.World J Transplant. 2017; 7: 250-259
- 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
- Comparable engraftment kinetics following peripheral-blood stem-cell infusion mobilized with granulocyte colony-stimulating factor with or without cyclophosphamide in multiple myeloma.J Clin Oncol. 1998; 16: 1547-1553
- Comparison of peripheral blood progenitor cell mobilization in patients with multiple myeloma: high-dose cyclophosphamide plus GM-CSF vs G-CSF alone.Bone Marrow Transplant. 1997; 20: 211-217
- A comparison of toxicity following two different doses of cyclophosphamide for mobilization of peripheral blood progenitor cells in 116 multiple myeloma patients.Bone Marrow Transplant. 2001; 27: 837-842
- Low-dose or intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor for progenitor cell mobilisation in patients with multiple myeloma.Bone Marrow Transplant. 2003; 31: 347-351
- Intermediate-dose versus low-dose cyclophosphamide and granulocyte colony-stimulating factor for peripheral blood stem cell mobilization in patients with multiple myeloma treated with novel induction therapies.Biol Blood Marrow Transplant. 2012; 18: 1128-1135
- 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.Cytotherapy. 2007; 9: 539-547
- Treatment of autologous stem cell transplant-eligible multiple myeloma patients: ten questions and answers.Haematologica. 2014; 99: 408-416
- Current status of autologous stem cell transplantation for multiple myeloma.Blood Cancer J. 2019; 9: 44
- Single-dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma.J Clin Apher. 2019;
- Optimal chemo-mobilization for the collection of peripheral blood stem cells in patients with multiple myeloma.BMC Cancer. 2019; 19: 59
- High-dose cyclophosphamide with or without etoposide for mobilization of peripheral blood progenitor cells in patients with multiple myeloma: efficacy and toxicity.Bone Marrow Transplant. 2004; 34: 69-76
- Efficacy and safety of stem cell mobilization with cyclophosphamide plus etoposide versus cyclophosphamide alone.Przegl Lek. 2015; 72: 606-610
- The diagnosis and treatment of multiple myeloma.Dtsch Arztebl Int. 2016; 113: 470-476
- Novel agents and approaches for stem cell mobilization in normal donors and patients.Bone Marrow Transplant. 2012; 47: 1154-1163
- Preceding chemotherapy, tumour load and age influence engraftment in multiple myeloma patients mobilized with granulocyte colony-stimulating factor alone.Br J Haematol. 2001; 112: 242-247
- Successful mobilization of peripheral blood stem cells in heavily pretreated myeloma patients with G-CSF alone.Ann Hematol. 1998; 76: 257-262
- Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma.Biol Blood Marrow Transplant. 2009; 15: 718-723
- Fixed-dose single agent pegfilgrastim for peripheral blood progenitor cell mobilisation in patients with multiple myeloma.Br J Haematol. 2006; 133: 533-537
- Cyclophosphamide-based stem cell mobilization in relapsed multiple myeloma patients: a subgroup analysis from the phase III trial ReLApsE.Eur J Haematol. 2017; 99: 42-50
Published online: June 18, 2021
Accepted: June 17, 2021
Received in revised form: June 15, 2021
Received: March 21, 2021
© 2021 Published by Elsevier Ltd.