Mobilization policy in multiple myeloma: minimum target or law of redundancy? Two different approaches by the two sides of the Atlantic Ocean

Olivieri, Attilio; Saraceni, Francesco

doi:10.1038/bmt.2015.317

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…One option is tailoring the priming strategy: the eternal dispute between steady-state and chemo-mobilization would be resolved if we could appropriately personalize mobilization strategies. Our results clearly support the use of chemo-mobilization in pPM, confirming a growing body of evidence [32]. Second, we provide a strong suggestion for upfront use of Plerixafor in pPM.…”

Section: Discussionsupporting

confidence: 85%

Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score

Olivieri

Attolico²,

Nuccorini³

et al. 2018

Bone Marrow Transplant

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Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure.

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Section: Discussionsupporting

confidence: 85%