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Association between mobilization regimen and PFS after auto-SCT for multiple myeloma

Bone Marrow Transplantation volume 49, pages 1439–1441 (2014)Cite this article

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Filgrastim (G-CSF) is commonly combined with either chemotherapy (typically CY) or plerixafor for mobilization of hematopoietic stem cells (HSCs) before auto-SCT for multiple myeloma. These G-CSF-based combinations are often preferred to G-CSF alone because they reliably allow collection of sufficient HSCs for multiple auto-SCTs.1 Few studies have examined the association between mobilization regimen and post-auto-SCT multiple myeloma outcomes. One retrospective analysis compared outcomes after mobilization with G-CSF+CY vs G-CSF alone and found no PFS difference;2 this study, however, pre-dated the availability of plerixafor and widespread use of pretransplant lenalidomide and bortezomib. The prospective, randomized study of plerixafor in multiple myeloma patients did not include a chemotherapy-based mobilization arm and did not report long-term multiple myeloma outcomes.3 Mobilization regimen could plausibly affect outcomes through differential effects on pre-auto-SCT disease burden, graft purity or post-auto-SCT immune reconstitution. For example, chemotherapy-based mobilization may have beneficial anti-myeloma cytotoxic effects, particularly since most multiple myeloma patients now receive little or no pre-auto-SCT chemotherapy. Alternatively, plerixafor may protect against progression by boosting post-auto-SCT lymphocyte counts4,5 but may also mobilize multiple myeloma cells.6 We therefore examined post-auto-SCT PFS according to mobilization regimen in a single-institution cohort of multiple myeloma patients.

Patients were included in this analysis if they underwent melphalan-conditioned (200 mg/m2) auto-SCT for multiple myeloma at the University of Pennsylvania between January 2010 (when commercially supplied plerixafor was first used at our center) and May 2013 following HSC mobilization/collection with either G-CSF+CY (G/Cy: CY 3 g/m2 on day 1+G-CSF 10 μg/kg/day starting day 4 or 5 with initiation of HSC collection when the circulating CD34pos cell count was ⩾6/μl) or G-CSF+plerixafor (G/P: as described previously,3 G-CSF 10 μg/kg/day starting day 1+plerixafor 0.24 mg/kg/day starting before the first HSC collection on day 4), the two most commonly used regimens at our center during this period. Mobilization regimen was selected by the treating physician with no pre-specified algorithm. Patients were excluded from the analysis if >12 months elapsed between diagnosis and auto-SCT, if >8 weeks elapsed between HSC collection and auto-SCT, if tandem auto-SCT or post-auto-SCT consolidation or experimental immunotherapy was used, or if >1 round of HSC mobilization was required to collect adequate HSCs. Retrospective analysis of this cohort was approved by the Institutional Review Board of the University of Pennsylvania.

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Acknowledgements

This work was partially supported by grants from the National Institutes of Health (T32CA009615 (ALG) and K23CA130074 (DTV)), and the Institute for Translational Medicine and Therapeutics of the University of Pennsylvania (ALG).

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Hematologic Malignancies Program, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    A L Garfall, A L Dougherty, D T Vogl, B M Weiss, A D Cohen & E A Stadtmauer

  2. Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    R Mick

  3. Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    U O'Doherty

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  1. A L Garfall
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  2. A L Dougherty
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Correspondence to E A Stadtmauer.

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Garfall, A., Dougherty, A., Vogl, D. et al. Association between mobilization regimen and PFS after auto-SCT for multiple myeloma. Bone Marrow Transplant 49, 1439–1441 (2014). https://doi.org/10.1038/bmt.2014.153

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