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Higher efficacy of intermediate dose cytarabine + G‐CSF compared to cyclophosphamide + G‐CSF in hematopoietic stem cell mobilization in patients with multiple myeloma
Author(s) -
BoguckaFedorczuk Aleksandra,
Czyz Anna,
Kalicińska Elżbieta,
Sawicki Mateusz,
LaszkowskaLewko Magdalena,
WicherskaPawłowska Katarzyna,
Rybka Justyna,
Szeremet Agnieszka,
Prajs Iwona,
Szymczak Donata,
Wróbel Tomasz
Publication year - 2020
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21784
Subject(s) - medicine , multiple myeloma , cytarabine , cyclophosphamide , cd34 , haematopoiesis , granulocyte colony stimulating factor , hematopoietic stem cell transplantation , cohort , gastroenterology , stem cell , plerixafor , transplantation , chemotherapy , immunology , cxcr4 , biology , chemokine , receptor , genetics
Background There are several regimens used in hematopoietic stem cell (HSC) mobilization in multiple myeloma (MM). Cyclophosphamide (Cy) is one of the most commonly used agents, although it does not always result in collecting adequate number of CD34+ cells. Recently, cytarabine (Ara‐C) has been proposed as potentially efficient and safe option. Aims Since the data regarding Ara‐C in HSC mobilization is limited, the aim of our study was to compare retrospectively the efficiency and toxicity of G‐CSF combined with either Ara‐C or Cy in MM patients. Materials & Methods Of a total of 89 patients, 43 received low or intermediate doses of Cy, and 46 were treated with 800 mg/m 2 /day of Ara‐C administered for two days. Results The mean peak of CD34+ cells/ul in peripheral blood was 132 (range, 84‐202) in Ara‐C and 51 (range, 29‐69) in Cy cohort ( p < 0.001). The median number of collected CD34+ cells (×106/kg) was 10.3 (range, 4.2‐17.9) vs 4.5 (range, 2.7‐8.9), respectively ( p < 0.001). Mobilization failure was observed in one patient in Ara‐C cohort (2%) and in 8 patients treated with Cy (19%) ( p = 0.013). In the Ara‐C group 98% of patients obtained more than 4×106 CD34+ cells/kg required for tandem transplantation. Moreover, we observed a trend toward increased paraprotein levels measured at transplant compared to before HSC mobilization in Ara‐C cohort and significantly higher transfusion rates in that group. Conclusion Our findings confirm higher HSC mobilization efficacy of Ara‐C compared to Cy in MM patients. However, lower transfusions rate and better disease control of Cy may justify its use in some cases.