Vinorelbine plus intermediate dose cyclophosphamide is an effective and safe regimen for the mobilization of peripheral blood stem cells in patients with multiple myeloma
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- Annunziata, M., Celentano, M., Pocali, B. et al. Ann Hematol (2006) 85: 394. doi:10.1007/s00277-005-0058-0
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High dose cyclophosphamide (HD-Cy) is commonly used to mobilize stem cells in multiple myeloma (MM). However, timing of collection is variable and incidence of side effects is substantial. We evaluated a combination of vinorelbine (VNB) (25 mg/m2 day 1) plus Cy (1.5 g/m2 day 2) and G-CSF as mobilizing regimen in 37 patients with MM. Results were compared to those achieved in 41 previously diagnosed patients mobilized with Cy at 4 g/m2. Overall, 36/37 patients receiving VNB–Cy (97%) mobilized, as opposed to 40/41 (97%) in the controls (p:0.51). Median CD34+ cells peak was 94/μl for VNB–Cy patients and 96 for controls, p=0.36; median number of CD34+ cells collected was 9.2×106/kg and 8.7×106/kg, respectively (p=0.85). Median number of days to the highest CD34 count was shorter for VNB–Cy patients (nine vs 11, p=0.001). No VNB–Cy patient experienced grade 3–4 neutropenia and thrombocytopenia, as opposed to 63 and 19% in the controls (p=0.001 and 0.01, respectively). Hospitalization from toxicity was never required in VNB–Cy patients as compared to 19% in control group (p=0.01). We conclude that an outpatient combination of VNB plus intermediate dose Cy plus G-CSF is a safe, predictable, and highly effective mobilization regimen for patients with newly-diagnosed MM.