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Blood graft cellular composition and posttransplant outcomes in myeloma patients mobilized with or without low‐dose cyclophosphamide: a randomized comparison
Author(s) -
Valtola Jaakko,
Silvennoinen Raija,
Ropponen Antti,
Siitonen Timo,
Säily Marjaana,
Sankelo Marja,
Terävä Venla,
Putkonen Mervi,
Kuittinen Taru,
Pelkonen Jukka,
Mäntymaa Pentti,
Remes Kari,
Varmavuo Ville,
Jantunen Esa
Publication year - 2016
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13574
Subject(s) - medicine , multiple myeloma , cyclophosphamide , cd34 , lymphocyte , transplantation , dexamethasone , melphalan , granulocyte colony stimulating factor , gastroenterology , urology , immunology , chemotherapy , stem cell , biology , genetics
BACKGROUND Autologous stem cell transplantation is a standard treatment in multiple myeloma (MM). Blood grafts are usually collected after mobilization with granulocyte–colony‐stimulating factor (G‐CSF) alone or in a combination with cyclophosphamide (CY). There is limited knowledge of the possible effects of different mobilization regimens on blood graft characteristics and posttransplant outcomes. STUDY DESIGN AND METHODS Thirty‐eight patients with MM were included in this study. The patients were randomly assigned at registration to mobilization with either low‐dose CY plus G‐CSF (Arm A) or G‐CSF alone (Arm B) and received three cycles of lenalidomide, bortetzomib, and dexamethasone induction. Flow cytometry analysis of lymphocyte subsets in the blood grafts after cryopreservation was performed. Hematologic and immune recovery were evaluated up to 12 months posttransplant. RESULTS The blood grafts in Arm A contained significantly more CD34+ cells but in Arm B there was a greater proportion of CD34+CD38– cells and higher numbers of T and B lymphocytes as well as natural killer (NK) cells. The engraftment was comparable but lymphocyte count at 15 days posttransplant was higher in Arm B (0.8 × 10 9 /L vs. 0.5 × 10 9 /L, p = 0.033). At 3 and 6 months posttransplant the total number of NK cells was also higher in G‐CSF–mobilized patients. There was no difference in progression‐free survival between the study arms. CONCLUSION CY plus G‐GSF yields more CD34+ cells but seems to diminish lymphocyte and NK cell counts in the grafts and hampers immune recovery after transplantation. Thus G‐CSF alone might be a preferred mobilization method due to more rapid immune recovery posttransplant.