1. Cyclophosphamide-based stem cell mobilization in relapsed multiple myeloma patients: A subgroup analysis from the phase III trial ReLApsE.
- Author
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Baertsch MA, Schlenzka J, Lisenko K, Krzykalla J, Becker N, Weisel K, Noppeney R, Martin H, Lindemann HW, Haenel M, Nogai A, Scheid C, Salwender H, Fenk R, Graeven U, Reimer P, Schmidt-Hieber M, Goerner M, Schmidt-Wolf IGH, Klein S, Ho AD, Goldschmidt H, and Wuchter P
- Subjects
- Adult, Aged, Cyclophosphamide adverse effects, Female, Granulocyte Colony-Stimulating Factor administration & dosage, Granulocyte Colony-Stimulating Factor adverse effects, Humans, Male, Middle Aged, Peripheral Blood Stem Cells cytology, Peripheral Blood Stem Cells drug effects, Peripheral Blood Stem Cells metabolism, Recurrence, Time-to-Treatment, Transplantation, Autologous, Treatment Outcome, Cyclophosphamide administration & dosage, Hematopoietic Stem Cell Mobilization methods, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Multiple Myeloma pathology, Multiple Myeloma therapy
- Abstract
Objective: Analysis of the efficiency and toxicity of cyclophosphamide-based stem cell mobilization in patients with relapsed multiple myeloma (RMM)., Methods: Peripheral blood stem cells (PBSCs) were mobilized with high dose cyclophosphamide (2 g/m
2 daily on days 1 and 2) and G-CSF plus pre-emptive/rescue plerixafor in RMM patients (first to third relapse) treated within the ReLApsE trial of the German-Speaking Myeloma Multicenter Group (GMMG)., Results: Mobilization was initiated with high-dose cyclophosphamide (HD-CY) and G-CSF in 30 patients. Fifteen patients received additional pre-emptive/rescue administration of plerixafor. Stem cell collection was successful (≥2×106 CD34+ cells per kg bw) in 77% (23/30 patients). Patients with prior high-dose melphalan collected a significantly lower median total number of PBSCs than patients without prior high-dose melphalan (3.3×106 vs 17×106 CD34+ cells/kg bw). Toxicity of HD-CY was frequent with 12 serious adverse events (SAE) in 37% of patients (11/30 patients). Infections accounted for the majority of SAE reports. In two patients, SAEs were lethal (septic shock)., Conclusions: These data proof feasibility of PBSC collection at relapse but emphasize the importance of collection and storage of additional PBSC transplants during first-line treatment when mobilization is more efficient and less toxic., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2017
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