Comparison of the efficiency, safety, and survival outcomes in two stem cell mobilization regimens with cyclophosphamide plus G-CSF or G-CSF alone in multiple myeloma: a meta-analysis

Abstract

Autologous stem cell transplantation as a frontline treatment for patients with multiple myeloma (MM) requires an adequate peripheral blood stem cell (PBSC) collection before processing. Granulocyte-colony stimulating factor (G-CSF) with or without cyclophosphamide (CTX) is a common regimen for PBSC mobilization; their benefits and risks are controversial. To compare the efficiency, safety, and survival outcomes between the two regimens, we conducted a meta-analysis including 18 studies with 4 prospective and 14 retrospective studies; a total of 2770 patients with MM were analyzed. The CTX plus G-CSF regimen had higher yields of total CD34+ cells (SMD = 0.39, 95% CI (0.30, 0.49)), and higher mobilization rates of the target ⩾ 2 × 106/kg (OR = 3.34, 95% CI (1.82, 6.11)) and 4 × 106/kg (OR = 2.16, 95% CI (1.69, 2.76)) cells. A favorable event-free survival (EFS) (HR = 0.73, 95% CI (0.58, 0.93), p = 0.01) and better 3-year EFS rate (OR = 1.65, 95% CI (1.1, 2.47), p = 0.02) were also reached in the patients with CTX plus G-CSF mobilization, although the risks of admission (OR = 26.49, 95% CI (7.31, 95.97)) and fever (OR = 13.66, 95% CI (6.21, 30.03)) during mobilization were increased, the treatment-related mortality was consistent (p = 0.26). The CTX plus G-CSF regimen was superior to the G-CSF-alone regimen for PBSC mobilization in patients with MM.

Efficacy of hematopoietic stem cell mobilization regimens in patients with hematological malignancies: a systematic review and network meta-analysis of randomized controlled trials

“…For the past time, cyclophosphamide was the most commonly used mobilizing chemotherapeutic agent both in patients with MM. A meta-analysis including both prospective and retrospective studies suggested that cyclophosphamide 1–g/m 2 plus G-CSF (RD or SD) is associated with significantly higher CD34 + cells yield in patients with MM when compared with G-CSF alone, which is consistent with our results [ 72 ]. A RCT reported by Czerw et al .…”

“…To the best of our knowledge, this is the first network meta-analysis comparing the efficacy of stem cell mobilization regimens in patients with hematological malignancies. Several traditional meta-analyses have been published in recent years, but they only could evaluate two regimens, such as G-CSF plus Plerixafor versus G-CSF alone, and pegylated G-CSF versus non-pegylated G-CSF [ 69 – 72 ] The relative effects of many other mobilization regimens are unclear due to the lack of direct comparison and integrated study. Our study overcome this limitation through pooling both direct and indirect evidences with network meta-analysis.…”

Prolonged Lenalidomide Induction Does Not Significantly Impair Stem Cell Collection in Multiple Myeloma Patients Mobilized With Cyclophosphamide or Plerixafor: A Report From The Covid Era

“… 14 Mobilization with cyclophosphamide and/or plerixafor is routinely employed at our center, and we have had very few patients in whom collection of sufficient cells for transplant has failed. This is consistent with studies suggesting that use of cyclophosphamide 15 , 16 , 17 , 18 , 19 and/or plerixafor 20 , 21 , 22 , 23 enables the majority of lenalidomide treated patients to collect adequate cells for transplant, even among those treated with more than 6 cycles of lenalidomide. 24 However, few studies have explored the impact of prolonged induction in substantial number of patients, and no studies have described the impact of prolonged induction in patients mobilized exclusively with the assistance of cyclophosphamide or plerixafor.…”

“…The initial studies describing a significant inhibitory effect of lenalidomide on stem cell collection were performed in patients mobilized mostly with G-CSF alone. 7 , 8 , 9 , 10 , 11 , 12 , 13 Later studies that included patients who were treated with lenalidomide induction and mobilized with the addition of cyclophosphamide 15 , 16 , 17 , 18 , 19 or plerixafor 20 , 21 , 22 , 23 demonstrated a significant improvement in stem cell yield such that most patients were able to collect sufficient cells for transplant. These studies did not specifically investigate whether prolonged induction with lenalidomide affects stem cell collection, as lenalidomide induction is typically capped at 6 cycles.…”

Automated chemotherapy compounding: Process optimization for the preparation of admixture containing high-dose of cyclophosphamide

“…Under this light, granulocyte-colony stimulating factor (G-CSF) with or without CTX is a common regimen for peripheral blood stem cell (PBSC) mobilization. 1 Successful stem cell mobilization and adequate collection of PBSCs are essential for patients undergoing ASCT.…”