Cytarabine + G-CSF is more effective than cyclophosphamide + G-CSF as a stem cell mobilization regimen in multiple myeloma.

Abstract

Cyclophosphamide (Cy) plus granulocyte-colony stimulating factor (G-CSF) is currently a standard regimen for hematopoietic stem cell (HSC) mobilization in patients with multiple myeloma (MM). However, cytarabine (AraC) in intermediate doses plus G-CSF seems to have a higher mobilization efficacy. The aim of this study was to retrospectively compare mobilization using AraC and Cy. Thirty consecutive MM patients were mobilized by Cy + G-CSF, and the subsequent 40 patients by AraC + G-CSF. Both groups were comparable. The target yield of 10 × 106 CD34+ cells/kg (for tandem and 2 additional transplantations) was achieved in 98% (AraC) and 57% (Cy) of patients (p < 0.0001) by 1.2 and 2.1 apheresis (means), and by single apheresis in 83 and 17% of patients, respectively. AraC mobilization resulted in higher peak concentration of CD34+ cells in blood (median 238.0 vs. 87.9/µL, p < 0.0001) and higher CD34+ yield (median 28.6 × 106 vs. 10.4 × 106/kg, p < 0.0001) compared to Cy mobilization. Toxicities were comparable except for thrombocytopenia gr. 4, observed in 50% of patients after AraC (Cy 7%). In view of these results, we conclude that mobilization with AraC plus G-CSF is very effective with acceptable toxicity and could be considered in MM patients with planned or expected higher numbers of transplantations.

• Authors: Tomas Jelinek, Lucie Adamusova, Tereza Popkova, Ivana Tvrda, Jana Smejkalova, Michal Simicek, Dana Salounova, Michal Kascak, Jana Mihalyova, Hana Plonkova, Juraj Duras, Milan Navratil, Roman Hajek, Zdenek Koristek
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 54 Issue 7 Pg. 1107-1114 (07 2019) ISSN: 1476-5365 [Electronic] England
• PMID: 30459429 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cytarabine
• Granulocyte Colony-Stimulating Factor
• Cyclophosphamide

Topics

• Adult
• Aged
• Autografts
• Cyclophosphamide (administration & dosage, adverse effects)
• Cytarabine (administration & dosage, adverse effects)
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage, adverse effects)
• Hematopoietic Stem Cell Mobilization
• Humans
• Male
• Middle Aged
• Multiple Myeloma (blood, therapy)
• Retrospective Studies
• Stem Cell Transplantation