, Volume 131, Issue 4, pp 214-218
Date: 23 Dec 2004

Myeloma cell contamination of peripheral blood stem-cell grafts can predict the outcome in multiple myeloma patients after high-dose chemotherapy and autologous stem-cell transplantation

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Abstract

Purpose

High-dose chemotherapy with hematopoietic stem-cell rescue is increasingly being used in the treatment of multiple myeloma. Bone marrow and also peripheral blood stem-cell (PBSC) grafts contain measurable quantities of plasma cells, the biological significance of which is unknown.

Methods

Patients with multiple myeloma were mobilized with chemotherapy and filgrastim. The number of CD38++/CD138+ cells/kg in the grafts for autologous transplantation was determined by flow cytometry. Patients were stratified into two groups (threshold 4.5×105 plasma cells kg-1) of reinfused plasma cells in the first autologous graft.

Results

The median statistical progression-free survival was 14 months (4–34 months) in the high-contamination group (>4.5×105 plasma cells kg-1) compared to 26 months (4–43 months) in the low-contamination group (<4.5×105 plasma cells kg-1, P =0.0096). Patients with 13q deletion were more frequently found to have a high contamination of the stem-cell graft with malignant plasma cells.

Conclusions

Patients with graft contamination of more than 4.5×105 plasma cells kg-1 had a high risk of early disease progression after high-dose chemotherapy. In vivo tumor cell purging prior to mobilization chemotherapy might be one strategy to improve the time to progression of high-risk patients.