Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies

Mehdi Hamadani, S. Thomas Kochuparambil, Salman Osman, Aaron Cumpston, Sonia Leadmon, Pamela Bunner, Kathy Watkins, Devi Morrison, Ethan Speir, David DeRemer, Vamsi Kota, Anand Jillella, Michael Craig, Farrukh Awan

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.

Original languageEnglish (US)
Pages (from-to)1128-1135
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number7
DOIs
StatePublished - Jul 1 2012

Fingerprint

Hematopoietic Stem Cell Mobilization
Granulocyte Colony-Stimulating Factor
Multiple Myeloma
Cyclophosphamide
Therapeutics
Stem Cells
Blood Cells
Peripheral Blood Stem Cells
Transplantation
Induction Chemotherapy
Poisons

Keywords

  • Autologous transplantation
  • Chemomobilization
  • High dose therapy
  • Lenalidomide

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies. / Hamadani, Mehdi; Kochuparambil, S. Thomas; Osman, Salman; Cumpston, Aaron; Leadmon, Sonia; Bunner, Pamela; Watkins, Kathy; Morrison, Devi; Speir, Ethan; DeRemer, David; Kota, Vamsi; Jillella, Anand; Craig, Michael; Awan, Farrukh.

In: Biology of Blood and Marrow Transplantation, Vol. 18, No. 7, 01.07.2012, p. 1128-1135.

Research output: Contribution to journalArticle

Hamadani, Mehdi ; Kochuparambil, S. Thomas ; Osman, Salman ; Cumpston, Aaron ; Leadmon, Sonia ; Bunner, Pamela ; Watkins, Kathy ; Morrison, Devi ; Speir, Ethan ; DeRemer, David ; Kota, Vamsi ; Jillella, Anand ; Craig, Michael ; Awan, Farrukh. / Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies. In: Biology of Blood and Marrow Transplantation. 2012 ; Vol. 18, No. 7. pp. 1128-1135.
@article{a8d41ef0679940b4b2d72a049108141c,
title = "Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies",
abstract = "Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.",
keywords = "Autologous transplantation, Chemomobilization, High dose therapy, Lenalidomide",
author = "Mehdi Hamadani and Kochuparambil, {S. Thomas} and Salman Osman and Aaron Cumpston and Sonia Leadmon and Pamela Bunner and Kathy Watkins and Devi Morrison and Ethan Speir and David DeRemer and Vamsi Kota and Anand Jillella and Michael Craig and Farrukh Awan",
year = "2012",
month = "7",
day = "1",
doi = "10.1016/j.bbmt.2012.01.005",
language = "English (US)",
volume = "18",
pages = "1128--1135",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Intermediate-Dose versus Low-Dose Cyclophosphamide and Granulocyte Colony-Stimulating Factor for Peripheral Blood Stem Cell Mobilization in Patients with Multiple Myeloma Treated with Novel Induction Therapies

AU - Hamadani, Mehdi

AU - Kochuparambil, S. Thomas

AU - Osman, Salman

AU - Cumpston, Aaron

AU - Leadmon, Sonia

AU - Bunner, Pamela

AU - Watkins, Kathy

AU - Morrison, Devi

AU - Speir, Ethan

AU - DeRemer, David

AU - Kota, Vamsi

AU - Jillella, Anand

AU - Craig, Michael

AU - Awan, Farrukh

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.

AB - Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide (ID-CY) and granulocyte colony-stimulating factor (G-CSF) has been shown to be more efficacious, albeit more toxic, than low-dose cyclophosphamide (LD-CY) mobilization regimens in patients with multiple myeloma treated with conventional therapies. However, the relative importance of cyclophosphamide dose intensity in peripheral blood progenitor cell mobilization after novel induction regimens is not known. Here we report mobilization outcomes of 123 patients who underwent transplantation within 1 year of starting induction chemotherapy with novel agents. We compared consecutive patients undergoing mobilization with ID-CY/G-CSF (3-4 g/m2) at one institution (n = 55) with patients receiving LD-CY/G-CSF (1.5 g/m2) at a different transplantation center (n = 68). At baseline, the 2 groups were well balanced, except for more frequent previous lenalidomide use in the ID-CY group (P = .04). Compared with LD-CY, ID-CY use was associated with higher median peak PB CD34+ cell count (35/μL versus 160/μL; P < .001), CD34+ cell yield on day 1 of collection (2.6 × 106/kg versus 11.7 × 106/kg, P ≤ .001), and total CD34+ cell yield (7.5 × 106/kg versus 16.6 × 106/kg; P ≤ .001). Six patients in the LD-CY group had mobilization failure, compared with no patients in the ID-CY group. A significantly higher proportion of patients in the LD-CY group (P < .001) were unable to collect ≥5 × 106/kg and ≥10 × 106/kg CD34+ cells. Neutrophil and platelet engraftment were significantly faster in the ID-CY group, likely because of higher infused CD34+ cell doses. In conclusion, compared with LD-CY, ID-CY produced a more robust peripheral blood progenitor cell mobilization and significantly reduced the rates of mobilization failure. These data caution against the use of LD-CY-containing mobilization strategies in patients with multiple myeloma undergoing stem cell collection after novel induction regimens.

KW - Autologous transplantation

KW - Chemomobilization

KW - High dose therapy

KW - Lenalidomide

UR - http://www.scopus.com/inward/record.url?scp=84862147136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862147136&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2012.01.005

DO - 10.1016/j.bbmt.2012.01.005

M3 - Article

C2 - 22248715

AN - SCOPUS:84862147136

VL - 18

SP - 1128

EP - 1135

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 7

ER -