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Jantunen E, Partanen A, Turunen A, Varmavuo V, Silvennoinen R. Mobilization Strategies in Myeloma Patients Intended for Autologous Hematopoietic Cell Transplantation. Transfus Med Hemother 2023; 50:438-447. [PMID: 37899993 PMCID: PMC10603622 DOI: 10.1159/000531940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Multiple myeloma is currently the leading indication for autologous hematopoietic cell transplantation (AHCT). A prerequisite for AHCT is mobilization and collection of adequate blood graft to support high-dose therapy. Current mobilization strategies include granulocyte colony-stimulating factor (G-CSF) alone or in combination with chemotherapy most commonly cyclophosphamide (CY). More recently, plerixafor has become into agenda especially in patients who mobilize poorly. In the selection of a mobilization method, several factors should be considered. Summary Preplanned collection target is important as G-CSF plus plerixafor is more effective in the mobilization of CD34+ cells than G-CSF alone. On the other hand, CY plus G-CSF is superior to G-CSF only mobilization. Previous therapy and age of the patients are important considerations as G-CSF alone may not be effective enough in patients with risk factors for poor mobilization. These factors include extensive lenalidomide exposure, irradiation to bone marrow-bearing sites, higher age, or a previous mobilization failure. Also, local preferences and experiences as well as the number of apheresis needed are important issues as well as cost-effectiveness considerations. Mobilization method used may have implication for cellular composition of collected grafts, which might have an impact on posttransplant events such as hematologic and immune recovery in addition to also potential long-term outcomes. Key Message Currently, G-CSF alone and preemptive plerixafor if needed might be considered as a standard mobilization strategy in MM patients intended for AHCT.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Antti Turunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Raija Silvennoinen
- Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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2
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Chen Y, Gao S, Wang Y, Lu M, Chu B, Shi L, Xiang Q, Fang L, Ding Y, Wang M, Liu X, Zhao X, Sun K, Bao L. Pre-mobilization platelet count predicts stem cell yield during mobilization in patients with multiple myeloma. CANCER PATHOGENESIS AND THERAPY 2023; 1:40-45. [PMID: 38328606 PMCID: PMC10846336 DOI: 10.1016/j.cpt.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/05/2022] [Accepted: 11/27/2022] [Indexed: 02/09/2024]
Abstract
Background Autologous hematopoietic stem cell (HSC) transplantation remains the recommended treatment for eligible patients with multiple myeloma (MM). Increasing the number of transplanted CD34+ cells shorten the time to hematopoietic reconstitution and increases the overall survival of patients. With the harvest of a sufficient CD34+ cell number being crucial, this study aimed to predict the factors that affect stem cell collection. Methods We conducted a retrospective study of 110 patients who were newly diagnosed with MM and underwent autologous HSC collection at Beijing Jishuitan Hospital between March 2016 and July 2022. Multiple factors were analyzed using the Mann-Whitney U tests for between-group comparisons. Differences were considered statistically significant at P < 0.05. Results We found that patient age affected stem cell collection significantly; for patients younger than 55 years, the number of CD34+ cells harvested may be ≥ 2 × 106/L, is unlikely to reach 5 × 106/L. Platelet count at initial mobilization was a predictor of the number of CD34+ cells collected. Collection may fail when the platelet count at initial mobilization is below 177 × 109/L and may be excellent when it is higher than 199 × 109/L. Conclusions This finding could guide us to predict the approximate number of CD34+ cells collected in advance during autologous transplant mobilization for MM and to decide in advance whether to apply plerixafor to improve the number of HSCs collected.
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Affiliation(s)
- Yuan Chen
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Shan Gao
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yutong Wang
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Minqiu Lu
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Bin Chu
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Lei Shi
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Qiuqing Xiang
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Lijuan Fang
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yuehua Ding
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Mengzhen Wang
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xi Liu
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xin Zhao
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Kai Sun
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Li Bao
- Hematology Department, Beijing Jishuitan Hospital, Beijing 100035, China
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Yang C, Dehghani M, Hopman W, Bhella S. Are we choosing mobilization regimens for autologous stem cell transplantation in multiple myeloma wisely: A single center comparison of GCSF+/-plerixafor vs cyclophosphamide/GCSF+/-plerixafor. J Clin Apher 2022; 37:348-353. [PMID: 35218068 DOI: 10.1002/jca.21976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) is a standard consolidation treatment for eligible patients with multiple myeloma (MM). There is no standardized mobilization regimen for collection of CD34+ stem cells, which is crucial to the success of ASCT. Cyclophosphamide/GCSF is an effective regimen, although reported associated toxicities include risk of febrile neutropenia (FN). Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. This single center, retrospective, quality improvement study evaluates mobilization and ASCT outcomes of MM patients who had undergone stem cell mobilization at KHSC with cyclophosphamide/GCSF+/-plerixafor without antibiotics, cyclophosphamide/GCSF+/-plerixafor with antibiotics, and GCSF+/-plerixafor without antibiotics. METHODS A retrospective chart review was conducted evaluating 137 patients. The primary outcome measure was FN rates with mobilization. Balancing measures include CD34+ cell collected, plerixafor usage, days of apheresis and transplant outcomes. Chi-square, ANOVA, or Kruskal-Wallis methods were used to test statistical significance where appropriate. RESULTS Our study noted a higher total and day one CD34+ count in the two groups utilizing cyclophosphamide in mobilization. All nine cases of FN occurred in these two groups (P < .05). Addition of antibiotics decreased, but did not eliminate risk of FN. There were no significant differences in the rate of plerixafor usage and number of apheresis days. Difference in transplant outcomes, including engraftment and transfusion support, were statistically but not clinically significant. A larger sample size may be needed to explore this fully. There was no significant difference in length of transplant hospital stay. CONCLUSION The elimination of cyclophosphamide from mobilization regimens for MM appears to significantly reduce FN rates, without increasing balancing measures such as total number of apheresis days, plerixafor usage, duration of transplant hospitalization or mortality outcomes.
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Affiliation(s)
- Chloe Yang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Dehghani
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Iida S, Ishida T, Horimoto K, Kazama H, Kim H, Crawford B, Teshima T. Medical database analysis of japanese multiple myeloma patients with planned stem cell transplantation (MEDALIST) - a focus on healthcare resource utilization and cost. Int J Hematol 2020; 113:271-278. [PMID: 33063174 DOI: 10.1007/s12185-020-03022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
This study explored the burden associated with stem cell mobilization, with or without cyclophosphamide (CPA), in patients who intended to receive autologous stem cell transplantation (ASCT) for multiple myeloma (MM). A Japanese health care claims database (MDV) was used to analyze the health care resource utilization patterns and medical cost between 2013 and 2016 (pre-plerixafor launch). The patients were further categorized into groups who received granulocyte-colony stimulating factor (G-CSF) alone or G-CSF + CPA group and analyzed in both mobilization and ASCT phases of treatment. Overall, there were more MM patients who were treated with G-CSF + CPA combination therapy than G-CSF alone. Length-of-stay was 1.6 times longer in the combination group during the mobilization phase. A reverse trend was observed during the ASCT phase. Direct cost was approximately 1.2 million yen during the mobilization phase and 2.3 million yen during the ASCT phase, with hospitalization basic fee accounting for the highest proportion in both groups and phases. A substantial amount of healthcare resource and cost was consumed in both phases. This study may serve as a basic reference for further health technology assessment of new medicines such as plerixafor. Further investigation of differences between treatment groups is warranted.
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Affiliation(s)
- Shinsuke Iida
- Department of Hematology and Oncology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | | | | | | | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
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Luoma S, Anttila P, Säily M, Lundan T, Heiskanen J, Siitonen T, Kakko S, Putkonen M, Ollikainen H, Terävä V, Sankelo M, Partanen A, Launonen K, Räsänen A, Sikiö A, Suominen M, Bazia P, Kananen K, Lievonen J, Selander T, Pelliniemi TT, Ilveskero S, Huotari V, Mäntymaa P, Tienhaara A, Jantunen E, Silvennoinen R. RVD induction and autologous stem cell transplantation followed by lenalidomide maintenance in newly diagnosed multiple myeloma: a phase 2 study of the Finnish Myeloma Group. Ann Hematol 2019; 98:2781-2792. [PMID: 31673775 PMCID: PMC6900265 DOI: 10.1007/s00277-019-03815-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/08/2019] [Indexed: 01/25/2023]
Abstract
Autologous stem cell transplantation (ASCT) combined with novel agents is the standard treatment for transplant-eligible, newly diagnosed myeloma (NDMM) patients. Lenalidomide is approved for maintenance after ASCT until progression, although the optimal duration of maintenance is unknown. In this trial, 80 patients with NDMM received three cycles of lenalidomide, bortezomib, and dexamethasone followed by ASCT and lenalidomide maintenance until progression or toxicity. The primary endpoint was the proportion of flow-negative patients. Molecular response was assessed if patients were flow-negative or in stringent complete response (sCR). By intention to treat, the overall response rate was 89%. Neither median progression-free survival nor overall survival (OS) has been reached. The OS at 3 years was 83%. Flow-negativity was reached in 53% and PCR-negativity in 28% of the patients. With a median follow-up of 27 months, 29 (36%) patients are still on lenalidomide and 66% of them have sustained flow-negativity. Lenalidomide maintenance phase was reached in 8/16 high-risk patients but seven of them have progressed after a median of only 6 months. In low- or standard-risk patients, the outcome was promising, but high-risk patients need more effective treatment approach. Flow-negativity with the conventional flow was an independent predictor for longer PFS.
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Affiliation(s)
- Sini Luoma
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Pekka Anttila
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjaana Säily
- Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland
| | - Tuija Lundan
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Hospital, Turku, Finland
| | - Jouni Heiskanen
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Siitonen
- Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland
| | - Sakari Kakko
- Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland
| | - Mervi Putkonen
- Hematology Unit, Turku University Hospital, Turku, Finland
| | - Hanna Ollikainen
- Department of Medicine, Satakunta Central Hospital, Pori, Finland
| | - Venla Terävä
- Hematology Unit, Tampere University Hospital, Tampere, Finland
| | - Marja Sankelo
- Hematology Unit, Tampere University Hospital, Tampere, Finland
| | - Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
- Department of Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Kirsi Launonen
- Hematology-Oncology Unit, Oulu University Hospital, Oulu, Finland
- Department of Medicine, Länsi-Pohja Central Hospital, Kemi, Finland
| | - Anu Räsänen
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Anu Sikiö
- Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Merja Suominen
- Department of Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Piotr Bazia
- Department of Medicine, Kainuu Central Hospital, Kajaani, Finland
| | | | - Juha Lievonen
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Virva Huotari
- Fimlab Laboratories Ltd., Tampere, Finland
- NordLab Oulu, Oulu University Hospital, Oulu, Finland
| | - Pentti Mäntymaa
- Laboratory of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Anri Tienhaara
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Hospital, Turku, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, North Carelia Hospital District, Joensuu, Finland
| | - Raija Silvennoinen
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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6
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López-Castaño F, Manresa P, Díaz V, Arranz E, López J, Pérez M, Alda O, Hernández L. Comparison and cost analysis of three protocols for mobilization and apheresis of haematopoietic progenitor cells. J Clin Apher 2019; 34:461-467. [PMID: 30817045 DOI: 10.1002/jca.21699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/16/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Autologous bone marrow transplantation is a component of the malignant hemopathy therapy. The preferred mobilization and collection method is apheresis. The aim of this study is to compare three protocols analyzing the effect of plerixafor, higher dose of G-CSF and large volume leukapheresis (LVL). MATERIALS AND METHODS A retrospective cohort study including 119 patients referred for mobilization. Three protocols were compared: (a) G-CSF 10 μg/kg/day subcutaneous (sc) × 4 days mobilizing 1 to 1.5 blood volumes. (b) G-CSF 10 μg/kg/day sc × 4 days + plerixafor 0.24 mg/kg/day sc preventively or as a rescue agent mobilizing 1 to 1.5 blood volumes. (c) G-CSF 20 μg/kg/day sc × 4 days ± plerixafor 0.24 mg/kg/day sc preventively or as a rescue agent mobilizing 3 to 4 blood volumes. RESULTS The average number of days of apheresis was reduced to 1.37 with protocol 3. The average cost per patient was reduced by 67% compared with protocol 2 and increased by only 5% compared with protocol 1, reducing the failure rate to 0%. CONCLUSION Adding preemptive or rescue plerixafor (protocol 2) to G-CSF 10 μg/kg/day alone (protocol 1) did not improve the days of apheresis nor the number of CD34+ cells collected but had higher cost and failure rate. Using LVL, plerixafor and G-CSF 20 μg/kg/day (protocol 3) decreased the number of sessions to 1.37, reduced the failure rate to 0% and led to a significant increase in the number of CD34+ cells collected without toxicity and with a similar cost to protocol 1.
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Affiliation(s)
- Francisco López-Castaño
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Pablo Manresa
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Vanesa Díaz
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Eva Arranz
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Javier López
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - María Pérez
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Olga Alda
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Luis Hernández
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
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Partanen A, Valtola J, Ropponen A, Kuitunen H, Kuittinen O, Vasala K, Ågren L, Penttilä K, Keskinen L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Comparison of filgrastim, pegfilgrastim, and lipegfilgrastim added to chemotherapy for mobilization of CD34 + cells in non-Hodgkin lymphoma patients. Transfusion 2018; 59:325-334. [PMID: 30450652 DOI: 10.1111/trf.14993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are limited on the long-acting granulocyte-colony stimulating factors (G-CSFs) pegfilgrastim (PEG) and lipegfilgrastim (LIPEG) compared with filgrastim (FIL) regarding the mobilization efficiency of CD34+ cells, graft cellular composition, and engraftment. STUDY DESIGN AND METHODS In this prospective nonrandomized study, 36 patients with non-Hodgkin lymphoma received FIL, 67 received PEG, and 16 patients received LIPEG as a cytokine after chemotherapy. We analyzed the mobilization and collection of CD34+ cells, cellular composition of blood grafts, and hematologic recovery after auto-SCT according to the type of G-CSF used. RESULTS Patients in the LIPEG group had fewer apheresis sessions (1 vs. 2, p = 0.021 for FIL and p = 0.111 for PEG) as well as higher median blood CD34+ cell counts at the start of the first apheresis (LIPEG 74 × 106 /L vs. FIL 31 × 106 /L, p = 0.084 or PEG 27 × 106 /L, p = 0.021) and CD34+ yields of the first apheresis (FIL 5.1 × 106 /kg vs. FIL 2.3 × 106 /kg, p = 0.105 or PEG 1.8 × 106 /kg, p = 0.012). Also, the costs associated with G-CSF mobilization and apheresis were lower in the LIPEG group. The graft composition was comparable except for the higher infused CD34+ cell counts in the LIPEG group. The engraftment kinetics were significantly slower in the FIL group. CONCLUSION LIPEG appears to be more efficient compared with PEG after chemotherapy to mobilize CD34+ cells for auto-SCT demonstrated as fewer sessions of aphereses needed as well as 2.8-fold CD34+ cell yields on the first apheresis day. Early hematologic recovery was more rapid in the LIPEG group. Thus further studies on LIPEG in the mobilization setting are warranted.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - H Kuitunen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - O Kuittinen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - L Ågren
- Siunsote- Hospital District of North Karelia, Joensuu, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland.,The Finnish Medicines Agency, Kuopio, Finland
| | - L Keskinen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Eastern Finland Laboratory Centre, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Siunsote- Hospital District of North Karelia, Joensuu, Finland.,Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Partanen A, Valtola J, Silvennoinen R, Ropponen A, Siitonen T, Putkonen M, Sankelo M, Pelkonen J, Mäntymaa P, Varmavuo V, Jantunen E. Impact of lenalidomide-based induction therapy on the mobilization of CD34 + cells, blood graft cellular composition, and post-transplant recovery in myeloma patients: a prospective multicenter study. Transfusion 2017; 57:2366-2372. [PMID: 28681435 DOI: 10.1111/trf.14220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lenalidomide is an immunomodulatory drug that is also currently used in transplant-eligible patients with multiple myeloma. Previous studies have suggested a negative impact of lenalidomide on the mobilization of CD34+ cells. No data are available regarding the more detailed composition of blood grafts after lenalidomide. STUDY DESIGN AND METHODS In a multicenter, prospective study, we analyzed the mobilization of CD34+ cells, graft cellular composition, and post-transplant hematologic recovery in 26 patients with multiple myeloma after lenalidomide-based induction and in 34 lenalidomide-naive controls with multiple myeloma. All patients were mobilized with low-dose cyclophosphamide plus granulocyte-colony-stimulating factor. The cellular composition of the grafts was analyzed from thawed, cryopreserved samples with flow cytometry. Graft function was evaluated by engraftment data and by complete blood counts until 12 months after the graft infusion. RESULTS Patients in the lenalidomide arm had lower median peak CD34+ counts and approximately 40% lower CD34+ cell yields from the first apheresis session, but these differences were not significant. The median total number of CD34+ cells collected was comparable (6.4 vs. 7.5 × 106 /kg). The number of apheresis sessions was higher in the lenalidomide group (2 vs. 1; p = 0.039). The blood graft composition was comparable between the groups. Hematologic recovery within 12 months post-transplant did not differ between the groups. CONCLUSION Lenalidomide-based induction seems to have an impact on the number of aphereses performed, but not on the total yields of the CD34+ cells in the graft. Neither cellular composition of the grafts nor post-transplant recovery was affected by the limited pre-transplant exposure to lenalidomide.
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Affiliation(s)
- Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Valtola
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Raija Silvennoinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Division of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - Timo Siitonen
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Mervi Putkonen
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Marja Sankelo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jukka Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.,Laboratory Center of Eastern Finland, Kuopio, Finland
| | | | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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9
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Jantunen E, Varmavuo V, Valtola J. Plerixafor injection: a hematopoietic stem cell mobilizer in non-Hodgkin lymphoma and multiple myeloma. Expert Rev Hematol 2016; 9:723-32. [DOI: 10.1080/17474086.2016.1208082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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