Abstract
Collection of hematopoietic progenitor cells (HPC) after previous autologous hematopoietic progenitor cell transplant (aHCT) was studied in 221 patients with multiple myeloma (MM). With a total of 333 collections, the median number of CD34+ cells collected was 4.7 × 106 CD34+ cells/kg, and 74% of the patients collected ⩾2.5 × 106 CD34+ cells/kg. Among 26 variables examined, the strongest predictor for poor collection was a platelet count <100 × 106/l before mobilization (P<0.001). A subsequent aHCT was performed in 154 of the 221 patients. Sole use of HPC procured after aHCT in 86 patients was associated with delayed platelet recovery (P<0.001) and linked to development of myelodysplastic syndrome (MDS)-associated cytogenetic abnormalities (MDS-CA; P=0.027, odds ratio (OR) 10.34) and a tendency towards clinical MDS/acute myeloid leukemia (AML; P=0.091, OR 3.57). However, treatment-related mortality (P=0.766) and time to absolute neutrophil count recovery ⩾0.5 × 109/l (P=0.879) were similar to when a pre-aHCT graft was used. Indeed, adding HPC collected before any aHCT neutralized the risk of MDS-CA or MDS/AML. Therefore, we advise generous initial HPC collection to broaden the salvage armamentarium for patients with MM.
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This research was presented in part at the American Society of Hematology Annual meeting, December 2012, Atlanta, GA, USA.
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BB received research funding from Celgene Corp. and Millennium Pharmaceuticals, Inc. and is a consultant for Celgene Corp., Millennium Pharmaceuticals, Inc., Onyx Pharmaceuticals, Inc. and Amgen, Inc. He is a co-inventor on patents and patent applications related to use of gene expression profiling in cancer medicine that have been licensed to Myeloma Health, LLC, but has no financial interests in this company. The remaining authors declare no conflict of interest.
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Conception and design: MCF, BB and XP. Administrative support: MCF and BB. Provision of study material or patients: MCF, ER, LNT, BB, JS and CJH. Collection and assembly of data: XP and LNT. Data analysis and interpretation: XP, ER, MCF and BB.
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Papanikolaou, X., Rosenbaum, E., Tyler, L. et al. Hematopoietic progenitor cell collection after autologous transplant for multiple myeloma: low platelet count predicts for poor collection and sole use of resulting graft enhances risk of myelodysplasia. Leukemia 28, 888–893 (2014). https://doi.org/10.1038/leu.2013.214
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DOI: https://doi.org/10.1038/leu.2013.214
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