Predicting poor peripheral blood stem cell collection in patients with multiple myeloma receiving pre-transplant induction therapy with novel agents and mobilized with cyclophosphamide plus granulocyte-colony stimulating factor: results from a Gruppo Italiano Malattie EMatologiche dell’Adulto Multiple Myeloma Working Party study

Abstract

Introduction: A still not well defined proportion of patients with multiple myeloma (MM) and eligible for autologous stem cell transplantation (AuSCT) fails to mobilize CD34+ peripheral blood stem cells (PBSC) at all or to collect an adequate number for a safe procedure or sufficient for multiple transplants. These so-called "poor-mobilizers" are difficult to be predicted, due to marked difference across previous heterogeneous studies.

Poor peripheral blood stem cell mobilization affects long‐term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation

“…Our definition of poor mobilizers was a practical one but slightly different from other definitions used in previous publications. Furthermore, in our program, we recommend non‐lenalidomide containing induction therapy, mainly cyclophosphamide/bortezomib/dexamethasone, which may explain the lower number of patients who received lenalidomide in their first induction regimen and possibly the relatively lower frequency of poor mobilizers (10.4%), whereas many other studies reported > 15% incidence . Another possible limitation is the relatively small number of patients treated with CXCR4 antagonist plerixafor.…”

“…In MM, multiple studies reported lenalidomide use to be another risk factor for poor mobilization . Most studies use different definitions for poor mobilization in MM patients, mainly due to the practice of collecting upfront adequate numbers of stem cells for two transplants …”

“…[16][17][18][19] Most studies use different definitions for poor mobilization in MM patients, mainly due to the practice of collecting upfront adequate numbers of stem cells for two transplants. [20][21][22] Poor mobilization prior to ASCT has important prognostic implications. In lymphoma, work from our institution demonstrated poor mobilizers (defined as inability to obtain 1 3 10 6 CD341 cells/kg ideal body weight [IBW] with two large volume apheresis) had a shortened PFS and OS compared to patients who were good mobilizers.…”

Comparison and cost analysis of three protocols for mobilization and apheresis of haematopoietic progenitor cells

“…However, the right timing for administration of plerixafor is unknown: preventively on the day before the start of collection or “on demand” (rescue) in cases of poor apheresis results. Thus, identifying candidate patients who are “poor mobilizers” is important, and numerous types of biological and clinical data have been proposed to be useful for identifying these patients, but there is no consensus on the use of these indicators . In addition, there are authors who have tried other mobilizing agents, such as bortezomib, in combination with the above mentioned agents.…”

Stem cell transplantation in multiple myeloma and other plasma cell disorders (report from an EBMT preceptorship meeting)

“…Factors associated with poor mobilization were age and hematological toxicity during prior induction. [12] Novel strategies for optimizing stem cell collection includes the addition of the alpha chemokine receptor CXCR4 antagonist plerixafor in selected patients. Lemoli et al reported a prospective study on the use of plerixafor in 83 MM patients who were poor mobilizers.…”