Work

173: Stem-Cell Collection Prior to Autologous Stem Cell Transplantation is Improved by Cyclophosphamide in Lenalidomide-Treated Patients with Multiple Myeloma

Year: 2008

Type: article

Abstract: Introduction: Recent studies discuss difficulty in collecting stem cells in multiple myeloma (MM) patients receiving lenalidomide-based induction therapy using filgastrim (granulocyte-colony stimulating factor [G-CSF]) in preparation for autologous stem cell transplantation (ASCT). It has also been suggested that treatment time beyond 4–6 cycles might hinder collection yields. Aim: To determine if addition of cyclophosphamide (CTX) to G-CSF as a mobilization regimen could rescue collection of adequate stem cells for at least two ASCTs in patients who had induction therapy with the BiRD (Biaxin [clarithromycin]/Revlimid [lenalidomide]/Dexamethasone) regimen. Method: Each 28-day cycle, patients received: clarithromycin 500 mg po BID for days 1–28, lenalidomide 25 mg po daily for days 1–21, and dexamethasone 40 mg po weekly on days 1, 8, 15, and 21. Patients were treatment naive, with Stage II or III MM by Durie-Salmon criteria. Prior to stem cell mobilization, BiRD therapy was held for a minimum of 14 days. Stem cell collection was performed after either G-CSF alone at a dose 10 mcg/kg/day for 5–10 consecutive days until a total of 10 × 106/kg CD34+ stem cells had been collected, or with addition of CTX at a dose of 3 g/m2 once prior to initiation of G-CSF therapy. Results: 28 patients underwent stem cell collection. Stem cell mobilization was attempted with G-CSF alone in 9 instances, and with CTX+G-CSF in 20 instances (1 patient underwent mobilization with both). In comparison with G-CSF alone, CTX+G-CSF yielded a significantly greater stem cell collection (mean CD34+ cells collected: 3.78 × 106/kg vs. 32.33 × 106/kg, P < 0.0001). Only 33% of patients who attempted stem cell mobilization with G-CSF alone obtained sufficient CD34+ cell yield vs. 100% of the patients mobilized with CTX+G-CSF (P < 0.0001). The extent of BiRD therapy prior to stem cell mobilization ranged from 2–27 cycles. The number of cycles of BiRD did not significantly impact the success rate of stem cell collection (P = 0.14). Conclusion: The patients mobilized with CTX+G-CSF had a higher collection of CD34+ cells, and enough stem cells for two ASCTs were harvested from them. There was no association between duration of BiRD therapy and successful CD34+ cell collection. Thus, lenalidomide-based induction therapy can be continued until desired tumor reduction goal is achieved, and CTX in addition to G-CSF should be used to ensure successful stem cell harvest prior to ASCT.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.182