Cyclophosphamide plus etoposide is a safe and effective mobilization regimen in patients with multiple myeloma.

Abstract

High-dose chemotherapy followed by autologous stem cell transplantation is a major component in the treatment of patients with multiple myeloma. As a prerequisite, the successful collection of a sufficient number of viable peripheral blood hematopoietic CD34+ cells is critical. A common standard protocol for mobilization is currently not defined and critically discussed especially in German-speaking Europe. In times of the Covid-19 pandemic, safe and effective strategies have to be chosen to minimize hospitalization times and severe courses. In this single-center retrospective analysis, safety and efficacy of cyclophosphamide plus etoposide (CE) and growth-factor support (n = 33) was compared to cyclophosphamide mono treatment and growth-factor support (n = 49) in 82 patients with multiple myeloma at first diagnosis. CE was superior to cyclophosphamide mono with a significantly higher number of collected CD34+ cells (15.46 × 106 CD34+ cells/kg vs. 9.92 × 106 CD34+ cells/kg), significantly faster engraftment of granulocytes after stem cell transplantation (day 10.5 vs. day 11.6), shorter duration of the inpatient stay (17.47 days vs. 19.16 days) and significantly less transfusions (8.82 % vs. 30.61 % patients receiving transfusions). The safety profile was comparable in both groups and in line with published data. We conclude that CE is a safe and highly effective mobilization protocol in patients with multiple myeloma at first diagnosis and appears to be superior to the commonly used cyclophosphamide mono regimen.

• Authors: Michael Heider, Sandra Grass, Veronika Dill, Stephanie Rämisch, Christof Winter, Mareike Verbeek, Katharina S Götze, Florian Bassermann, Stefanie Jilg
• Journal: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis (Transfus Apher Sci) Vol. 60 Issue 5 Pg. 103197 (Oct 2021) ISSN: 1473-0502 [Print] England
• PMID: 34175195 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Ltd.

Chemical References

• Myeloma Proteins
• Granulocyte Colony-Stimulating Factor
• Etoposide
• Cyclophosphamide
• Melphalan

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• COVID-19
• Cyclophosphamide (administration & dosage, adverse effects, pharmacology)
• Etoposide (administration & dosage, adverse effects, pharmacology)
• Female
• Granulocyte Colony-Stimulating Factor (pharmacology)
• Hematopoietic Stem Cell Mobilization (methods)
• Hematopoietic Stem Cells (drug effects)
• Humans
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Multiple Myeloma (blood, therapy)
• Myeloma Proteins (analysis)
• Pandemics
• Peripheral Blood Stem Cell Transplantation (methods)
• Retrospective Studies
• SARS-CoV-2
• Transplantation, Autologous