Intermediate-dose CY and G-CSF more efficiently mobilize adequate numbers of PBSC for tandem autologous PBSC transplantation compared with low-dose CY in patients with multiple myeloma.

Abstract

BACKGROUND:

Autologous PBSC transplantation is the standard care for patients with multiple myeloma. The most common regimen used to mobilize PBSC consists of CY and G-CSF.

METHODS:

We retrospectively analyzed the efficacy and toxicity of two regimens of CY for PBSC mobilization: low-dose CY (1-2 g/m(2), LD-CY, n=61) plus G-CSF, and intermediate-dose CY (3-4 g/m(2), ID-CY, n=26) plus G-CSF.

RESULTS:

In the LD-CY group, 5.17 (0.23-17.3)x10(6) CD34(+) cells/kg, and in the ID-CY group 7.71 (0.08-26.4)x10(6) CD34(+) cells/kg (P=0.018), were collected. Although >/=2x10(6)/kg CD34(+) cells were collected in 89% of the LD-CY group and 92% of the ID-CY group, this was achieved after a single leukapheresis in 54% of the LD-CY group and 92% of the ID-CY group (P=0.0001). Patients who are to have tandem autologous PBSC transplants require >/=4x10(6)/kg CD34(+) cells. This was achieved in only 65% patients in the LD-CY group but 88% in the ID-CY group (P=0.05). Among patients who had not had prior melphalan and/or >12 months of prior treatment, 74% in the LD-CY group and 100% in ID-CY group mobilized >/=4x10(6)/kg CD34(+) cells. Febrile neutropenia was more frequent in the ID-CY group (38% vs. 13%).

DISCUSSION:

In conclusion, compared with LD-CY, patients receiving ID-CY were more likely to collect a total CD34(+) cell number adequate for tandem autologous PBSC transplantation. The increased toxicity was manageable and considered acceptable.

• Authors: D K Hiwase, G Bollard, S Hiwase, M Bailey, J Muirhead, A P Schwarer
• Journal: Cytotherapy (Cytotherapy) Vol. 9 Issue 6 Pg. 539-47 ( 2007) ISSN: 1465-3249 [Print] England
• PMID: 17882718 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antigens, CD34
• Granulocyte Colony-Stimulating Factor
• Cyclophosphamide

Topics

• Adult
• Aged
• Antigens, CD34 (metabolism)
• Cell Count
• Cyclophosphamide (administration & dosage, pharmacology)
• Demography
• Dose-Response Relationship, Drug
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage, pharmacology)
• Hematopoietic Stem Cell Mobilization (methods)
• Hematopoietic Stem Cells (cytology, drug effects)
• Humans
• Male
• Middle Aged
• Multiple Myeloma (surgery)
• Peripheral Blood Stem Cell Transplantation
• Retrospective Studies
• Transplantation, Autologous