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he paradigm for multiple myeloma (MM) therapy has evolved arkedly in the past decade with the introduction of numerus new drugs and improved patient outcomes.1 Autologous hematopoietic stem cell transplantation aHSCT) is widely used as part of first line therapy in the reatment of transplant-eligible patients with MM.2 In these atients, hematopoietic stem cell (HSC) mobilization for HSCT has commonly been performed using cyclophoshamide plus granulocyte-colony stimulating factor (G-CSF) r G-CSF alone.3,4 However, the induction regimens should ot increase the mobilization failure risk. This concern has een especially pertinent to patients previously exposed to yclophosphamide or lenalidomide during induction, as these rugs appear to hamper HSC mobilization. In the article that ccompanies this comment, Crusoe et al. demonstrate the easibility of using G-CSF alone to mobilize progenitor cells in M patients induced with a cyclophosphamide, thalidomide nd dexamethasone regimen.5 The number of CD34+ cells obilized was assessed after using G-CSF with or without yclophosphamide. The retrospective study of Crusoe et al. included eightyight MM patients who underwent aHSCT at two Brazilian enters.5 Collection of >2.0 × 106 CD34+ cells/kg was considred sufficient. The group that received cyclophosphamide

revista brasileira de hematologia e hemoterapia

Hematopoietic stem cell mobilization for autologous transplantation in multiple myeloma patients previously exposed to cyclophosphamide, thalidomide, and dexamethasone: is granulocyte-colony stimulating factor alone enough?