The Efficacy and Safety of Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma Patients That Are “Poor Responder” to Induction- The Mayo Clinic Experience

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Transplant Cell Ther. 2021 Jun 18:S2666-6367(21)01000-9. doi: 10.1016/j.jtct.2021.06.016. Online ahead of print.

ABSTRACT

We report the outcomes of 117 newly diagnosed multiple myeloma patients who received novel agents induction, had a poor response to induction and were mobilized using intravenous intermediate-dose cyclophosphamide (82%) or VD-PACE (18%) plus G-CSF and “on-demand” plerixafor. The median PFS and OS of the chemo-mobilized cohort were 21 months (95% 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 versus median 8.77 × 106 cells/kg, respectively (P<0.001)). The safety profile of chemo-mobilization was favorable, and there was no difference between the two groups in length of hospitalization during ASCT (P=0.95), days to neutrophil engraftment (P=0.22), days to platelet engraftment (P=0.27), and risk of bacteremia (P=0.52). 29% of the chemo-mobilized cohort and 65% of the matched cohort required plerixafor for adequate mobilization (P<0.001). Chemo-mobilization enhances stem cell collection without adversely impacting the post-transplant clinical course.

PMID:34153504 | DOI:10.1016/j.jtct.2021.06.016