Prospective identification of potential factors influencing stem cell mobilization and the necessity for plerixafor use in newly diagnosed multiple myeloma patients undergoing autologous stem cell transplantation

Abstract

Introduction To study the efficacy and safety of single large volume leukapheresis by using generic G-CSF or G-CSF plus Plerixafor in achieving adequate stem cell yield and various factors influencing thereof in newly diagnosed multiple myeloma patients undergoing autologous stem cell transplant . Method This prospective study was undertaken among 55 newly diagnosed multiple myeloma patients undergoing autologous stem cell transplant and aged between 18 and 75 years. Mobilization and harvesting of stem cells were performed by using GCSF or GCSF plus Plerixafor and large volume leukapheresis, respectively. A stem cell yield of ≥2 × 10 6 kg –1 and the number of apheresis procedures were primary efficacy endpoints, while the ideal stem cells yield >5 × 10 6 kg –1 , the engraftment day and D100 response/graft sustainability were secondary endpoints. Result The primary endpoint was achieved in all cases in both the groups by using a single LVL leukapheresis procedure. Fulfillment of all the secondary endpoints was satisfactory and comparable in both the groups. Age, pre-apheresis CD34+ count and number of interruptions during the LVL were significant factors influencing the stem cell yield ( p < 0.05). Adverse drug reactions during the apheresis and post-ASCT period were manageable. Conclusion The LVL is safe and cost-effective in attaining a minimum of CD34+ cells in a single procedure with manageable adverse reactions. Judicious intervention during the procedure may be helpful in ensuring the adequate yield.

Impact of Clinical Parameters and Induction Regimens on Peripheral Blood Stem-Cell Mobilization and Collection in Multiple Myeloma Patients

“…As demonstrated in most previous analyses, age does not seem to be associated with mobilization failure (<2 × 10 6 CD34 + cells/kg) [37, 43, 45]. However, some studies indicate an adverse effect [41, 44]. The present study indicates that age >60 years is disadvantageous with higher collection goals (4 or 6 × 10 6 CD34 + cells/kg).…”

G-CSF + plerixafor versus G-CSF alone mobilized hematopoietic stem cells in patients with multiple myeloma and lymphoma: a systematic review and meta-analysis

“…‘Blinding of patients and personnel’ and ‘selective reporting’ of eight articles [ 17–19 , 21–39 ] were assessed as low risk. In ‘random sequence generation’, bias in ten articles [ 17–19 , 23 , 24 , 28 , 35 , 38–40 ] was assessed as unclear risk. In ‘allocation concealment’, bias in five articles [ 17–19 , 28 , 35 , 38 ] was assessed as unclear risk.…”

“…In ‘random sequence generation’, bias in ten articles [ 17–19 , 23 , 24 , 28 , 35 , 38–40 ] was assessed as unclear risk. In ‘allocation concealment’, bias in five articles [ 17–19 , 28 , 35 , 38 ] was assessed as unclear risk. In ‘blinding of outcome assessment’, bias in one article [ 33 ] was assessed as unclear risk.…”

Steady‐state versus chemotherapy‐based hematopoietic cell mobilization after anti‐CD38‐based induction therapy in newly diagnosed multiple myeloma

“…13 Apart from the mobilization method itself, various factors including age, sex, prior therapy, or remission status before mobilization have previously been described to have an influence on the mobilization capacity and stem cell yield in myeloma patients. 12,14,15 However, in this context, the role of prior use of anti-CD38 mAb has not been fully elucidated. The limited data available from the first randomized trials and real-world cohorts describe the efficacy of anti-CD38 mAb in induction therapy and suggest an impaired stem cell yield requiring more frequent need of plerixafor to achieve sufficient stem cell mobilization and collection efficacy, [16][17][18] but in this context, the mobilization modalities have not yet been comparatively analyzed.…”

“…Apart from the mobilization method itself, various factors including age, sex, prior therapy, or remission status before mobilization have previously been described to have an influence on the mobilization capacity and stem cell yield in myeloma patients 12,14,15 . However, in this context, the role of prior use of anti‐CD38 mAb has not been fully elucidated.…”