The association of mobilising regimen on immune reconstitution and survival in myeloma patients treated with bortezomib, cyclophosphamide and dexamethasone induction followed by a melphalan autograft

Rees, M.; Mollee, Peter; Ng, Jun Yen; Murton, Alex; Gonsalves, José Filipe; Panigrahi, A. K.; Beer, Hayley; Loh, Joanna; Nguyen, P.T.B.; Hunt, Sam; Jina, Hayden; Wayte, Rebecca; Sutrave, Gaurav; Tan, Jocelyn; Abeyakoon, Chathuri; Chee, Ashlyn; Augustson, Bradley; Kalro, Akash; Lee, Cindy; Agrawal, S.; Чурилов, Леонид; Chua, Chong Chyn; Lim, Andrew; Zantomio, Daniela; Grigg, Andrew

doi:10.1038/s41409-021-01300-2

Cited by 6 publications

(5 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…was that lower‐dose cyclophosphamide (1.5–2 g/m 2 ) resulted in the same yields as higher dose cyclophosphamide (≥3 g/m 2 ) but with a lower risk of complications and lower cost overall. A recent multicentre retrospective study by Rees et al 17 . also assessed the impact of G‐CSF versus G‐CSF + Cyclo mobilisation on immune reconstitution and autograft outcomes in patients who received VCD induction.…”

Section: Discussionmentioning

confidence: 99%

“…Another important finding by Chyn et al was that lower-dose cyclophosphamide (1.5-2 g/m 2 ) resulted in the same yields as higher dose cyclophosphamide (≥3 g/m 2 ) but with a lower risk of complications and lower cost overall. A recent multicentre retrospective study by Rees et al 17 also assessed the impact of G-CSF versus G-CSF + Cyclo mobilisation on immune reconstitution and autograft outcomes in patients who received VCD induction. Peripheral blood lymphocyte count at day 15 after transplantation, used as a surrogate marker of host immune recovery, was significantly lower in patients who received G-CSF + Cyclo mobilisation.…”

Section: Peripheral Blood Stem Cell Mobilisationmentioning

confidence: 99%

See 1 more Smart Citation

Peripheral blood stem cell mobilisation following bortezomib, lenalidomide and dexamethasone induction for multiple myeloma: a real‐world single‐centre experience

Sim,

Quach,

Pham

et al. 2023

Internal Medicine Journal

View full text Add to dashboard Cite

BackgroundBortezomib, lenalidomide and dexamethasone (VRd) is now the standard‐of‐care induction therapy for newly diagnosed transplant‐eligible multiple myeloma patients, replacing bortezomib, cyclophosphamide and dexamethasone (VCD) therapy. Lenalidomide can negatively impact stem cell yield because of its myelosuppressive effects, although studies have shown that the latter can be overcome with the use of cyclophosphamide for peripheral blood stem cell (PBSC) mobilisation.Aims and MethodsTo investigate whether lenalidomide impacts on PBSC mobilisation and to evaluate the optimal mobilisation strategy post VRd induction, we performed a retrospective review of 56 myeloma patients at a single centre who had PBSC mobilisation between January 2019 and March 2021 and compared three cohorts: (i) VCD induction; mobilisation with granulocyte colony‐stimulating factor (G‐CSF) alone (n = 23); (ii) four cycles VRd induction; mobilisation with G‐CSF and cyclophosphamide (G‐CSF + Cyclo) (n = 20); and (iii) three cycles VRd induction; mobilisation with G‐CSF alone (n = 13).ResultsThere was no difference in the mean total CD34 count between VCD and VRd patients who had G‐CSF mobilisation (6.27 × 106/kg vs 5.50 × 106/kg, P > 0.99). VRd patients mobilised with G‐CSF + Cyclo achieved higher mean total CD34 counts compared with G‐CSF alone (8.89 × 106/kg vs 5.50 × 106/kg, P = 0.04). The majority of VRd patients who had G‐CSF + Cyclo (19 of 20; 95%) collected sufficient cells for two or more autologous stem cell transplants (ASCTs), regardless of whether this was required, compared with eight of 13 (62%) VRd patients who had G‐CSF alone.ConclusionWe conclude that successful PBSC mobilisation for at least one ASCT is possible after three cycles of VRd induction using G‐CSF alone. The upfront use of a cyclophosphamide‐based mobilisation strategy has a role in patients who have had VRd induction, where the aim is to collect enough stem cells for two or more ASCTs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Peripheral Blood Stem Cell Mobilisationmentioning

confidence: 99%

Peripheral blood stem cell mobilisation following bortezomib, lenalidomide and dexamethasone induction for multiple myeloma: a real‐world single‐centre experience

Sim,

Quach,

Pham

et al. 2023

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Moreover, AraC + G-CSF was also evaluated to be more efficient than CY + G-CSF as a stem cell mobilization regimen in MM patients [56]. Besides, a recent G-CSF cyclophosphamide 1-2 g/m 2 plus G-CSF (LD-CY) Cyclophosphamide 3-4 g/m 2 and G-CSF (ID-CY) Significantly higher lymphocyte dose was obtained with G-CSF alone compared with the LD-CY and ID-CY groups [99] G-CSF only vs. G-CSF and cyclophosphamide -G-CSF only mobilization showed significantly higher lymphocyte count at day 15 post-infusion (P < 0.001) -G-CSF only was associated with significantly improved OS (aHR = 0.60, 95% CI: 0.39-0.92, P = 0.018) [44] G-CSF plus plerixafor vs. cyclophosphamide plus G-CSF…”

Section: Chemomobilizationmentioning

confidence: 97%

“…The effects of major mobilization regimens on graft characteristics are presented in Table 1. Most of the studies showed a significantly higher dose of lymphocytes with G-CSF alone than G-CSF plus cyclophosphamide [7,44]. Furthermore, studies have proven the combination of G-CSF and plerixafor to be better than G-CSF alone with a significant increase in primitive CD34 + CD38 − cells by G-CSF plus plerixafor [45].…”

Section: Effect Of Mobilization Regimen On Graft Characteristicsmentioning

confidence: 99%

Stem cell mobilization in multiple myeloma: challenges, strategies, and current developments

Wei

2023

Ann Hematol

View full text Add to dashboard Cite

Among hematological malignancies, multiple myeloma (MM) represents the leading indication of autologous hematopoietic stem cell transplantation (auto-HCT). Auto-HCT is predominantly performed with peripheral blood stem cells (PBSCs), and the mobilization and collection of PBSCs are essential steps for auto-HCT. Despite the improved success of conventional methods with the incorporation of novel agents for PBSC mobilization in MM, mobilization failure is still a concern. The current review comprehensively summarizes various mobilization strategies for mobilizing PBSCs in MM patients and the evolution of these strategies over time. Moreover, existing evidence substantiates that the mobilization regimen used may be an important determinant of graft content. However, limited data are available on the effects of graft characteristics in patient outcomes other than hematopoietic engraftment. In this review, we discussed the effect of graft characteristics on clinical outcomes, mobilization failure, factors predictive of poor mobilization, and potential mobilization regimens for such patients.

show abstract

“…In some previous studies, a higher lymphocyte dose with clearly higher cutoffs has been associated with better posttransplant outcome potentially explained by a more rapid immune recovery associated with a higher graft lymphocyte dose [56, 57]. In a recent multicenter retrospective study, the G-CSF mobilization was associated with longer time to next treatment as well as better OS compared to CY + G-CSF mobilization possible due to better immune recovery posttransplant [58]. Clearly, more data are needed regarding potential prognostic value of immune cells in the grafts as well as importance of immune recovery for long-term myeloma control and outcome.…”

Section: How Much To Collect?mentioning

confidence: 99%

Mobilization Strategies in Myeloma Patients Intended for Autologous Hematopoietic Cell Transplantation

Jantunen,

Partanen,

Turunen

et al. 2023

Transfus Med Hemother

View full text Add to dashboard Cite

Background: Multiple myeloma is currently the leading indication for autologous hematopoietic cell transplantation (AHCT). A prerequisite for AHCT is mobilization and collection of adequate blood graft to support high-dose therapy. Current mobilization strategies include granulocyte colony-stimulating factor (G-CSF) alone or in combination with chemotherapy most commonly cyclophosphamide (CY). More recently, plerixafor has become into agenda especially in patients who mobilize poorly. In the selection of a mobilization method, several factors should be considered. Summary: Preplanned collection target is important as G-CSF plus plerixafor is more effective in the mobilization of CD34+ cells than G-CSF alone. On the other hand, CY plus G-CSF is superior to G-CSF only mobilization. Previous therapy and age of the patients are important considerations as G-CSF alone may not be effective enough in patients with risk factors for poor mobilization. These factors include extensive lenalidomide exposure, irradiation to bone marrow-bearing sites, higher age, or a previous mobilization failure. Also, local preferences and experiences as well as the number of apheresis needed are important issues as well as cost-effectiveness considerations. Mobilization method used may have implication for cellular composition of collected grafts, which might have an impact on posttransplant events such as hematologic and immune recovery in addition to also potential long-term outcomes. Key Message: Currently, G-CSF alone and preemptive plerixafor if needed might be considered as a standard mobilization strategy in MM patients intended for AHCT.

show abstract

The association of mobilising regimen on immune reconstitution and survival in myeloma patients treated with bortezomib, cyclophosphamide and dexamethasone induction followed by a melphalan autograft

Cited by 6 publications

References 41 publications

Peripheral blood stem cell mobilisation following bortezomib, lenalidomide and dexamethasone induction for multiple myeloma: a real‐world single‐centre experience

Peripheral blood stem cell mobilisation following bortezomib, lenalidomide and dexamethasone induction for multiple myeloma: a real‐world single‐centre experience

Stem cell mobilization in multiple myeloma: challenges, strategies, and current developments

Mobilization Strategies in Myeloma Patients Intended for Autologous Hematopoietic Cell Transplantation

Contact Info

Product

Resources

About