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Drozd-Sokołowska J, Waszczuk-Gajda A, Topczewska M, Maciejewska M, Dutka M, Zaucha JM, Szmigielska-Kapłon A, Nowicki M, Olszewska-Szopa M, Szeremet A, Czyż A, Kozioł M, Hus M, Mańko J, Hus I, Romejko-Jarosińska J, Kopińska A, Helbig G, Mądry K, Boguradzki P, Król M, Snarski E, Hayden PJ, Jamroziak K, Dwilewicz-Trojaczek J, Basak GW. Stem Cell Mobilization Performed with Different Doses of Cytarabine in Plasma Cell Myeloma Patients Relapsing after Previous Autologous Hematopoietic Cell Transplantation-A Multicenter Report by the Polish Myeloma Study Group. Cancers (Basel) 2024; 16:2588. [PMID: 39061226 PMCID: PMC11274934 DOI: 10.3390/cancers16142588] [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: 06/17/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Salvage autologous hematopoietic cell transplantation (auto-HCT) may be used to treat relapse of plasma cell myeloma occurring after previous auto-HCT. When an insufficient number of hematopoietic stem cells have been stored from the initial harvest, remobilization is necessary. Here, we aimed to analyze the efficacy and safety of different doses of cytarabine (total 800 vs. 1600 vs. 2400 mg/m2) for remobilization. Sixty-five patients, 55% male, with a median age at remobilization 63 years, were included. Remobilization was performed with cytarabine_800 in 7, cytarabine_1600 in 36, and cytarabine_2400 in 22 patients. Plerixafor rescue was used in 25% of patients receiving cytarabine_1600 and 27% of those receiving cytarabine_2400. Patients administered cytarabine_800 were not rescued with plerixafor. Remobilization was successful in 80% of patients (57% cytarabine_800; 86% cytarabine_1600; 77% cytarabine_2400; p = 0.199). The yield of collected CD34+ cells did not differ between the different cytarabine doses (p = 0.495). Patients receiving cytarabine_2400 were at the highest risk of developing severe cytopenias, requiring blood product support, or having blood-stream infections. One patient died of septic shock after cytarabine_2400. In summary, remobilization with cytarabine is feasible in most patients. All doses of cytarabine allow for successful remobilization. Cytarabine_2400 is associated with higher toxicity; therefore, lower doses (800 or 1600 mg/m2) seem to be preferable.
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Magdalena Topczewska
- Faculty of Computer Science, Bialystok University of Technology, 15-351 Bialystok, Poland;
| | - Martyna Maciejewska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Magdalena Dutka
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.D.); (J.M.Z.)
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.D.); (J.M.Z.)
| | - Anna Szmigielska-Kapłon
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland; (A.S.-K.); (M.N.)
| | - Mateusz Nowicki
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland; (A.S.-K.); (M.N.)
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.O.-S.); (A.S.); (A.C.)
| | - Agnieszka Szeremet
- Department of Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.O.-S.); (A.S.); (A.C.)
| | - Anna Czyż
- Department of Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.O.-S.); (A.S.); (A.C.)
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland; (M.K.); (M.H.); (J.M.); (I.H.)
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland; (M.K.); (M.H.); (J.M.); (I.H.)
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland; (M.K.); (M.H.); (J.M.); (I.H.)
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Iwona Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland; (M.K.); (M.H.); (J.M.); (I.H.)
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland; (A.K.); (G.H.)
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland; (A.K.); (G.H.)
| | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Emilian Snarski
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
- Faculty of Medicine and Health Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Patrick J. Hayden
- Department of Haematology, Trinity College Dublin, St. James’s Hospital, D08 NHY1 Dublin, Ireland;
| | - Krzysztof Jamroziak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
| | - Grzegorz Władysław Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.W.-G.); (M.M.); (K.M.); (P.B.); (M.K.); (E.S.); (K.J.); (J.D.-T.); (G.W.B.)
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Drozd-Sokołowska J, Gras L, Zinger N, Snowden JA, Arat M, Basak G, Pouli A, Crawley C, Wilson KMO, Tilly H, Byrne J, Bulabois CE, Passweg J, Ozkurt ZN, Schroyens W, Lioure B, Colorado Araujo M, Poiré X, Van Gorkom G, Gurman G, de Wreede LC, Hayden PJ, Beksac M, Schönland SO, Yakoub-Agha I. Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation-study on behalf of CMWP of the EBMT. Bone Marrow Transplant 2022; 57:633-640. [PMID: 35169284 PMCID: PMC8993690 DOI: 10.1038/s41409-022-01592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/23/2021] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.
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Affiliation(s)
| | - Luuk Gras
- EBMT Statistical Unit Data Office, Leiden, the Netherlands
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | - Grzegorz Basak
- Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland
| | - Anastasia Pouli
- Haematology Department, "St Savvas" Oncology Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | - Bruno Lioure
- Techniciens d'Etude Clinique suivi de patients greffes, Strasbourg, France
| | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | - Gunhan Gurman
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Meral Beksac
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Stefan O Schönland
- Medizinische Klinik u. Poliklinik V, University of Heidelberg, Heidelberg, Germany.
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000 Lille, Lille, France
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Drozd-Sokołowska J, Waszczuk-Gajda A, Biecek P, Kobylińska K, Mańko J, Hus I, Szmigielska-Kapłon A, Nowicki M, Romejko-Jarosińska J, Kozioł M, Sędzimirska M, Sachs W, Mądry K, Boguradzki P, Król M, Hus M, Basak G, Dwilewicz-Trojaczek J. Salvage autologous hematopoietic stem cell transplantation for multiple myeloma performed with stem cells procured after previous high dose therapy - a multicenter report by the Polish Myeloma Study Group. Leuk Lymphoma 2021; 62:3226-3234. [PMID: 34396931 DOI: 10.1080/10428194.2021.1950712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Salvage autologous hematopoietic stem cell transplantation (auto-HSCT) constitutes a therapeutic option for a group of well-selected patients with relapsed multiple myeloma (MM). However, if an insufficient number of stem cells were harvested and stored before the first auto-HSCT, stem cells need to be remobilized. Patients diagnosed with MM who following relapse after auto-HSCT, had remobilization and afterward, auto-HSCT with remobilized cells were included in this retrospective analysis. Thirty-three patients, 61% males, the median age 61 years, were included. With a median follow-up of 1.8 years, 2-year progression-free survival was 56.2%, non-relapse mortality 4.8%. The 2-year cumulative incidence of t-MDS was 4.9%. Factors important for the outcome were: the quality of response, previous radiotherapy, the time between the first and salvage auto-HSCT. To conclude, salvage auto-HSCT performed with cells procured after the previous auto-HSCT can be efficacious in relapsed MM, especially if a sufficiently long response had been obtained to the first auto-HSCT(s).
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Kobylińska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | | | - Mateusz Nowicki
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Mariola Sędzimirska
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Wojciech Sachs
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Drozd-Sokołowska J, Waszczuk-Gajda A, Topczewska M, Mańko J, Hus I, Szmigielska-Kapłon A, Nowicki M, Grygoruk-Wiśniowska I, Krawczyk-Kuliś M, Romejko-Jarosińska J, Frączak E, Wróbel T, Piątkowska-Jakubas B, Mądry K, Boguradzki P, Król M, Kozioł M, Hus M, Kopińska A, Dmoszyńska A, Basak GW, Dwilewicz-Trojaczek J. Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group. J Clin Apher 2021; 36:443-453. [PMID: 33592119 DOI: 10.1002/jca.21885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 12/05/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Salvage autologous hematopoietic stem cell transplantation (autoHSCT) may be used to treat relapse of multiple myeloma occurring after previous autoHSCT. When insufficient number of hematopoietic stem cells was stored from the initial harvest, remobilization of stem cells is necessary. PURPOSE The analysis of stem cell remobilization after previous autoHSCT. PATIENTS AND METHODS Fifty-eight patients, 60% males, median 59 years, were included. Median time interval between autoHSCT and remobilization was 42 months. The first remobilization was performed mostly after chemotherapy: cyclophosphamide (33%), cytarabine (43%), and etoposide (19%). RESULTS The first remobilization was successful in 67% patients. About 19% patients required plerixafor rescue, among whom it allowed for successful harvesting in 14%. Use of cyclophosphamide, cytarabine, and etoposide allowed for successful remobilization in 53%, 84%, and 55% patients, respectively. Patients treated with cytarabine had the highest yield of CD34+ cells (median 7.5 × 106 /kg vs 5.8 and 2.4 for etoposide and cyclophosphamide, P = .001). Higher percentage of patients was able to collect ≥2 × 106 CD34+ cells/kg during one leukapheresis after cytarabine (76% vs 21% for cyclophosphamide vs 36% for etoposide, P = .001). Cytarabine use was associated with lower risk of remobilization failure OR = 0.217, P = .02. Toxicity comprised mostly hematological toxicity (thrombocytopenia and neutropenia). One patient succumbed to septic shock. CONCLUSION Remobilization after previous autoHSCT is feasible only in a proportion of patients. Cytarabine is associated with the highest rate of successful mobilization and the highest yield of mobilized CD34+ cells. The toxicity requires careful surveillance of these patients.
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Topczewska
- Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Iwona Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Mateusz Nowicki
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Iwona Grygoruk-Wiśniowska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Krawczyk-Kuliś
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland.,Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute-Cancer Center, Gliwice, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Ewa Frączak
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Wróbel
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Anna Dmoszyńska
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Władysław Basak
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Montefusco V, Martinelli G, Cerchione C. How I manage frontline transplant-eligible multiple myeloma in Italy. Hematol Rep 2020; 12:8954. [PMID: 33042503 PMCID: PMC7520856 DOI: 10.4081/hr.2020.8954] [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: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022] Open
Abstract
The treatment of transplant-eligible multiple myeloma patients in Italy consists in an induction phase based on bortezomib plus thalidomide plus dexamethasone (VTd), followed by a single or tandem autologous stem cell transplantation (ASCT), followed by lenalidomide maintenance. This approach offers an overall response rate of 93% and a CR rate of 58% with acceptable toxicity. Lenalidomide maintenance adds a significant increase in disease control, with a progression free survival after ASCT of 53 months, and an overall survival of 86 months. Second primary malignancies represent the most concerning toxicity of lenalidomide maintenance with a 6.9% incidence. However, the benefit in terms of increased myeloma control largely outweigh this complication. The incorporation of daratumumab in this treatment schema will further improve these clinical results.
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Affiliation(s)
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
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Holstein SA, McCarthy PL. Improved survival with salvage autologous stem-cell transplantation in myeloma. LANCET HAEMATOLOGY 2017; 3:e306-7. [PMID: 27374462 DOI: 10.1016/s2352-3026(16)30058-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022]
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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, Wuchter P. Cyclophosphamide-based stem cell mobilization in relapsed multiple myeloma patients: A subgroup analysis from the phase III trial ReLApsE. Eur J Haematol 2017; 99:42-50. [PMID: 28370401 DOI: 10.1111/ejh.12888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
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/m2 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.
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Affiliation(s)
| | - Jana Schlenzka
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Lisenko
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Krzykalla
- Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Natalia Becker
- Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Weisel
- Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany
| | | | - Hans Martin
- Hematology and Oncology, Goethe University, Frankfurt, Germany
| | - Hans W Lindemann
- Hematology and Oncology, Kath. Krankenhaus Hagen gem. GmbH - St.-Marien-Hospital, Hagen, Germany
| | - Mathias Haenel
- Hematology, Oncology and Stem Cell Transplantation, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Axel Nogai
- Internal Medicine III, Charité Campus Benjamin Franklin, Berlin, Germany
| | | | - Hans Salwender
- Hematology, Oncology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany
| | - Roland Fenk
- Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Duesseldorf, Germany
| | - Ullrich Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - Peter Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | | | - Martin Goerner
- Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - Ingo G H Schmidt-Wolf
- Center for Integrated Oncology, Med. Klinik III, University Hospital Bonn, Bonn, Germany
| | - Stefan Klein
- Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Anthony D Ho
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Wuchter
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
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Garderet L, Cook G, Auner HW, Bruno B, Lokhorst H, Perez-Simon JA, Sahebi F, Scheid C, Morris C, van Biezen A, Sobh M, Michallet M, Gahrton G, Schönland S, Kröger N. Treatment options for relapse after autograft in multiple myeloma – report from an EBMT educational meeting. Leuk Lymphoma 2016; 58:797-808. [DOI: 10.1080/10428194.2016.1228926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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The effect of salvage autologous stem-cell transplantation on overall survival in patients with relapsed multiple myeloma (final results from BSBMT/UKMF Myeloma X Relapse [Intensive]): a randomised, open-label, phase 3 trial. LANCET HAEMATOLOGY 2016; 3:e340-51. [DOI: 10.1016/s2352-3026(16)30049-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022]
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