Blood stem cell collections in multiple myeloma: definition of a scoring system

Abstract

Summary:The purpose of the study was to identify factors that could predict good yields of peripheral blood stem cells (PBSC) in multiple myeloma (MM). Fifty-one MM patients, nine with refractory disease and 42 in plateau phase, were mobilized with high-dose cyclophosphamide (HD-Cy) at 4 g/m 2 followed by granulocyte colonystimulating factor (G-CSF) 5 g/kg/day. Clinical and laboratory parameters at the time of mobilization were analyzed for correlations with the number of CD34 + cells collected, with the colony-forming unit granulocyte-macrophage (CFU-GM) count, and the mononuclear cell (MNC) count. In univariate analysis, low WBC count, low platelet count, prior exposure to melphalan, and an interval Ͼ6 months from the start of treatment correlated with poor yields of CD34 + cells. Low platelet count, prior exposure to melphalan or to radiotherapy, and an interval Ͼ6 months from the start of treatment were associated with a low CFU-GM count. On the basis of these data, we defined a scoring system able to predict the yield of the mobilizing procedure. According to this system, the presence of more than one risk factor (low WBC and platelet counts, prior exposure to melphalan, interval from first chemotherapy Ͼ6 months) was predictive of insufficient collections when a conventional combination of mobilizing measures are used. Bone Marrow Transplantation (2000) 26, 283-286.

DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) is an effective regimen for peripheral blood stem cell collection in multiple myeloma

“…Notably, 10 out of 15 patients (67%) previously exposed to alkylating agents mobilized enough CD34 + cells to support high-dose melphalan-based autologous transplantation. These results compare favorably with those reported with CTX at 4 or 7 g/m 2 , 6,16,18,22 and are similar to those obtained with more intensive combination protocols. 15,16 These latter studies, however, showed considerable toxicity with prolonged neutropenia which entailed in the majority of patients septic complications, marked anemia, and thrombocytopenia with need for transfusions and hospitalization.…”

“…We have previously demonstrated the utility of a scoring system to identify patients at a high risk of yielding insufficient numbers of CD34 + cells. 22 In this report, we also show that the presence of more than one of the above-identified risk factors implies a high probability of collecting lower numbers of stem cells, in particular less than 4 ϫ 10 6 /kg, which is considered the standard target for a rapid recovery after PBSC-supported high-dose therapy in MM.…”

Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma

“…[4][5][6] These failure rates are higher than those reported in singlecenter studies (5%-23%). [7][8][9]16,17 Direct comparison of the findings of this study with these single-center studies is difficult because we used a standard dose of G-CSF (10 g/kg per day), a 3.0ϫ blood volume apheresis, and a primary endpoint that included the number of apheresis days. Although the use of higher doses of G-CSF could result in a higher CD34 ϩ cell yield, 18 other studies have reported that the failure rates remained high despite the higher doses of G-CSF used.…”

G-CSF plus plerixafor (Mozobil) to mobilize hematopoietic stem cells in patients with thrombocytopenia or leukopenia prior to auto-SCT

“…3,5 Thrombocytopenia (platelets p150 Â 10 9 /L) at the time of mobilization was consistently predictive of mobilization failure by univariate and multivariate analyses when examined in association with chemotherapy-based mobilization strategies. 2,3 Whether these trends hold true for patients who receive G-CSF plus plerixafor (a CXCR4 chemokine receptor antagonist), a recent addition to the therapeutic armamentarium, remains to be seen. 6 Phase 3 studies demonstrated a significant improvement in mobilization outcomes with G-CSF combined with plerixafor, compared with G-CSF alone, 1,7 in non-Hodgkin's lymphoma (NHL) and multiple myeloma patients.…”

“…1 Mobilization failure following cytokines with or without chemotherapy may be due to multiple factors including previous mobilization failure, 2,3 46 months from prior therapy to the start of mobilization, 3 prior therapy (for example, radiotherapy, melphalan, platinum-containing chemotherapy regimens, lenalidomide, fludarabine), [2][3][4] low premobilization platelet counts 2,3 and low WBC counts. 3,5 Thrombocytopenia (platelets p150 Â 10 9 /L) at the time of mobilization was consistently predictive of mobilization failure by univariate and multivariate analyses when examined in association with chemotherapy-based mobilization strategies. 2,3 Whether these trends hold true for patients who receive G-CSF plus plerixafor (a CXCR4 chemokine receptor antagonist), a recent addition to the therapeutic armamentarium, remains to be seen.…”