Safety and Efficacy of Granulocyte Colony–Stimulating Factor Monotherapy for Peripheral Blood Stem Cell Collection in POEMS Syndrome

Abstract

Although autologous stem cell transplantation can achieve excellent responses in patients with POEMS syndrome, the optimal regimen for peripheral blood stem cell (PBSC) collection is still controversial. We retrospectively investigated the safety and efficacy of 41 PBSC collecting procedures in 37 patients with POEMS syndrome. PBSC mobilization was performed using cyclophosphamide + granulocyte colony-stimulating factor (G-CSF) (CG, n = 14) or G-CSF alone (G, n = 27). Twelve (85.7%) patients in the CG group and all (100%) patients in the G group received induction chemotherapy before PBSC collection. The proportions of good mobilizers (≥2.0 × 10 CD34 cells/kg) were comparable between the 2 groups (CG versus G: 78.6% versus 70.4%, P = .71). Two (14.3%) patients in the CG group developed severe capillary leak symptoms during the PBSC mobilization period, whereas no patient in the G group experienced severe adverse events. Appropriate induction therapies followed by the G-CSF monotherapy compose an optimal strategy for PBSC collection.

Efficacy and Long-Term Outcomes of Autologous Stem Cell Transplantation in POEMS Syndrome: A Nationwide Survey in Japan

“…Although the adequacy of prophylactic treatment at the timing of engraftment is still unclear, it might be useful to prevent ES. We recently clarified the safety and efficacy of induction treatment before autologous peripheral stem cell mobilization in a single-center retrospective analysis [36]. Induction treatment may not be able to elicit a deep response; however, it is essential not only for the stability of patient symptoms and controlling of VEGF before ASCT but also for safe mobilization and reducing the risk of ES.…”

Autologous peripheral blood stem cell transplantation and the role of lenalidomide in patients affected by poems syndrome

“…The median number of CD34+ cells was 2.58 × 10 6 /kg (range, 0.77–10.90 × 10 6 /kg); it was higher in those who received cyclophosphamide plus G‐CSF (median, 2.68 vs 1.55 × 10 6 /kg, P < 0.001). Thus, the previously reported high incidence of poor mobilization in POEMS patients was associated to hepatomegaly, ascites, renal failure, and splenomegaly, but it was not confirmed in larger series and could be a manifestation of disease activity . Treatment with appropriate induction therapy to control the disease could be part of a strategy for efficient and safe PBSC collection .…”

“…38 Treatment with appropriate induction therapy to control the disease could be part of a strategy for efficient and safe PBSC collection. 38 In patients failing a successful mobilization, plerixafor was effective to ensure the transplant procedure. 34 The debate on the use of cyclophosphamide plus G-CSF or G-CSF alone to mobilize patients with POEMS should take into account been reported to be decreased after cyclophosphamide mobilization in some reports, 31 but not in others.…”

“…Recently Muto et al analyzed mobilization‐related complications of PBSC collection in POEMS syndrome patients: 19 (46.3%) of 41 patients developed mobilization‐related complications of all grades, higher in the chemo‐mobilization group than in the G‐CSF group, despite reports. The rate of the engraftment syndrome, characterized by fever, weight gain, pulmonary infiltrates, rashes, and diarrhea, has been reported to be decreased after cyclophosphamide mobilization in some reports, but not in others …”

“…Thus, the previously reported high incidence of poor mobilization in POEMS patients was associated to hepatomegaly, ascites, renal failure, and splenomegaly, but it was not confirmed in larger series and could be a manifestation of disease activity . Treatment with appropriate induction therapy to control the disease could be part of a strategy for efficient and safe PBSC collection . In patients failing a successful mobilization, plerixafor was effective to ensure the transplant procedure …”