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Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma

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Abstract

Introduction

Lenalidomide (LEN) is a relatively new and very effective therapy for multiple myeloma (MM). Prior LEN therapy is associated with an increased risk of peripheral blood stem cell collection (PBSC) failure, particularly with filgrastim (G-CSF) alone. We performed a retrospective chart review of 319 consecutive MM patients who underwent apheresis to collect PBSCs for the first autologous stem cell transplant (ASCT).

Results

The median number of PBSCs collected in the LEN (+) group was significantly less than the LEN (−) group (6.34 vs. 7.52 × 106 CD34+ cells/kg; p = 0.0004). In addition, the median number of apheresis sessions required for adequate PBSCs collection were significantly more in the LEN (+) group as compared to LEN (−) group (2 vs. 1 sessions; p = 0.002). In the LEN (+) group, there was a negative correlation between PBSCs collected and prior number of cycles of LEN (p = 0.0001). Rate of PBSC collection failure was 9 % in the LEN (+) group and 5 % in the LEN (−) group (p = 0.16). Only six patients who failed PBSC collection with G-CSF were able to collect adequate PBSCs with G-CSF + plerixafor. LEN exposure had no effect on neutrophil or platelet recovery post-ASCT.

Conclusions

Up to four cycles of LEN exposure have minimal negative impact on PBSC collection. Despite prolong exposure of LEN, PBSC collection was adequate for two ASCTs in the majority of patients and post-ASCT engraftment was not longer than expected; however, clinical relevance (complication rate, quality of life, cost) of prolonged LEN exposure on both PBSC and ASCT, should be evaluated in prospective clinical trials.

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Conflict of interest

Muneer H. Abidi: Speaker for Millennium Pharmaceutical

Jeffrey Zonder: Advisory Board for Celgene Pharmaceutical

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Authors and Affiliations

  1. Department of Bone Marrow Transplantation, Karmanos Cancer Institute, 4100 John R, 4 HWCRC, Rm: 4257, Detroit, MI, 48201, USA

    Divaya Bhutani, Jeffrey Zonder, Lois Ayash, Abhinav Deol, Zaid Al-Kadhimi, Judith Abrams, Lawrence Lum, Voravit Ratanatharathorn, Joseph Uberti & Muneer H. Abidi

  2. Cleveland Clinic, Cleveland, OH, USA

    Jason Valent

  3. Wayne State University, Detroit, MI, USA

    Divaya Bhutani, Lois Ayash, Abhinav Deol, Zaid Al-Kadhimi, Judith Abrams, Lawrence Lum, Voravit Ratanatharathorn, Joseph Uberti & Muneer H. Abidi

  4. Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Nishant Tageja

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  1. Divaya Bhutani
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  2. Jeffrey Zonder
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  3. Jason Valent
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  4. Nishant Tageja
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  5. Lois Ayash
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  7. Zaid Al-Kadhimi
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  8. Judith Abrams
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  9. Lawrence Lum
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  10. Voravit Ratanatharathorn
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  11. Joseph Uberti
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  12. Muneer H. Abidi
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Correspondence to Muneer H. Abidi.

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Bhutani, D., Zonder, J., Valent, J. et al. Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma. Support Care Cancer 21, 2437–2442 (2013). https://doi.org/10.1007/s00520-013-1808-5

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  • DOI: https://doi.org/10.1007/s00520-013-1808-5

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