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Comparison of engraftment following different stem cell mobilization modalities in patients with multiple myeloma treated with a uniform induction regimen containing bortezomib, cyclophosphamide and dexamethasone

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Abstract

Bortezomib-based induction followed by autologous stem cell transplantation is a common treatment for multiple myeloma (MM). Stem cell (SC) mobilization with granulocyte-colony stimulating factor (G-CSF) alone has become an alternative to G-CSF combined with chemotherapeutic agents. This study aimed to compare the efficacy of the two mobilization modalities following induction with a uniform regimen containing bortezomib, cyclophosphamide and dexamethasone (VCD). We retrospectively evaluated results of SC mobilization using either G-CSF alone or combined with high-dose cyclophosphamide (HD-CY) in MM patients after VCD induction. The primary endpoints of the study were engraftment and mobilization-associated toxicity. Parameters of stem cell collection, transplantation and engraftment were assessed. Data of 92 patients were analyzed [56 (61%) mobilized with HD-CY + G-CSF and 36 (39%) with G-CSF only]. HD-CY + G-CSF provided a higher number of CD34 + cells (15.9 vs 8.1 × 106/kg, p = 0.001) with fewer apheresis sessions. However, while no adverse events were observed in patients receiving G-CSF alone, nine patients (16%) receiving HD-CY + G-CSF developed neutropenic fever requiring hospitalization. Although a greater number of cells was transplanted following mobilization with HD-CY + G-CSF, neutrophil and platelet engraftment and duration of transplant-related hospitalization were similar in both cohorts. G-CSF alone provided a sufficient SC amount, without exposing patients to additional toxicity. While HD-CY + G-CSF resulted in a superior SC yield in MM patients induced with VCD, this advantage should be balanced against adverse effects of this mobilization regimen.

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Acknowledgements

The authors wish to acknowledge with thanks the assistance of Sonia Kamenetsky in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha’Aliya Street, 31096, Haifa, Israel

    Noam Benyamini, Eldad J. Dann, Tsila Zuckerman, Noa Lavi & Tami Katz

  2. Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Irit Avivi

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Irit Avivi

  4. Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Eldad J. Dann, Tsila Zuckerman, Noa Lavi & Tami Katz

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  1. Noam Benyamini
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  2. Irit Avivi
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  3. Eldad J. Dann
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  4. Tsila Zuckerman
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Correspondence to Noam Benyamini.

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The study was approved by the Institutional Review Board of the Rambam Health Care Campus (Approval # 0110-13 RMB).

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The authors declare no conflicts of interest.

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Noam Benyamini and Irit Avivi equally contributed to the article

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Benyamini, N., Avivi, I., Dann, E.J. et al. Comparison of engraftment following different stem cell mobilization modalities in patients with multiple myeloma treated with a uniform induction regimen containing bortezomib, cyclophosphamide and dexamethasone. Ann Hematol 96, 461–467 (2017). https://doi.org/10.1007/s00277-016-2897-2

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  • DOI: https://doi.org/10.1007/s00277-016-2897-2

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