The Efficacy and Safety of Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma Patients Who Are Poor Responders to Induction: The Mayo Clinic Experience

Iuliana Vaxman, Eli Muchtar, Eapen Jacob, Prashant Kapoor, Shaji Kumar, Angela Dispenzieri, Francis Buadi, David Dingli, Wilson Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Martha Lacy, William Hogan, Morie A. Gertz

Research output: Contribution to journalArticlepeer-review

Abstract

We report the outcomes of 117 patients with newly diagnosed multiple myeloma who received novel agent induction, had a poor response to induction, and were mobilized using intravenous intermediate-dose cyclophosphamide (82%) or VD-PACE (18%) plus granulocyte colony-stimulating factor (G-CSF) and on-demand plerixafor. The median progression-free survival and overall survival of the chemo-mobilized cohort were 21 months (95% confidence interval [CI], 15–71) and 58 months (95% CI, 47–80), respectively. We compared our cohort to a 117-patient cohort matched by the level of response at pretransplant evaluation. The matched patients were mobilized with G-CSF and on-demand plerixafor without chemotherapy. Patients receiving chemo-mobilization had higher stem cell yields than the growth-factor-only cohort (median, 10.7 × 106 cells/kg vs. 8.77 × 106 cells/kg, respectively; P <.001). The safety profile of chemo-mobilization was favorable, and there was no difference between the two groups in length of hospitalization during autologous stem cell transplantation (P =.95), days to neutrophil engraftment (P =.22), days to platelet engraftment (P =.27), or risk of bacteremia (P =.52). Twenty-nine percent of the chemo-mobilized cohort and 65% of the matched cohort required plerixafor for adequate mobilization (P <.001). Chemo-mobilization enhances stem cell collection without adversely impacting the post-transplant clinical course.

Original languageEnglish (US)
Pages (from-to)770.e1-770.e7
JournalTransplantation and Cellular Therapy
Volume27
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • Autologous stem cell transplantation
  • Chemo-mobilization
  • Cyclophosphamide
  • Mobilization

ASJC Scopus subject areas

  • Hematology
  • Transplantation
  • Immunology and Allergy
  • Cell Biology
  • Molecular Medicine
  • Medicine(all)

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