Authors (including presenting author) :
Tam KW, Leung KH, Lei WS, Pang CK, Fan TC, Lin SY
Affiliation :
Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Introduction :
Autologous haematopoietic stem cell transplantation is the standard treatment for multiple myeloma. Successful stem cell mobilization and harvest is the first and important step for transplantation. Use of granulocyte colony stimulating factor (GCSF) plus as required plerixafor and cyclophosphamide with GCSF are the two most commonly used mobilization strategies. There is no straightforward consensus on the selection of mobilization methods and the optimal strategy is yet to be determined.
Objectives :
Objectives :
To compare the mobilization outcome between GCSF plus as required plerixafor (GCSF+P
group) versus conventional cyclophosphamide with GCSF (CTX+GCSF group) for multiple
myeloma patients in two local hospitals.
Methodology :
Methodology :
Patients diagnosed with multiple myeloma aged 18 years or above who had their first stem cell mobilization from January 2013 to December 2018 in two regional hospitals were included. Stem cell mobilization outcome, subsequent transplant engraftment and survival data for the two different strategies were compared.
Result & Outcome :
Results :
74 patients were identified of which 47 used GCSF plus as required plerixafor and 27 used cyclophosphamide plus GCSF as mobilization strategy. Total stem cell yield was significantly higher in the CTX+GCSF group (median of 14.11 vs. 6.72 x 10^6 cells/kg, p <0.01). Less number of apheresis (median of 1 vs. 2 sessions, p <0.01) was required for CTX+GCSF group but the total hospitalization days for the mobilization and stem cell collection process was longer (median of 11 vs. 6 days, p <0.01). Subgroup analysis of 15 patients used plerixafor from the GCSF+P group demonstrated an excellent success rate on collecting the optimal target stem
cell dose of ≥ 5 x 10^6 cells/kg comparable to the CTX+GCSF group (86% vs. 91%, p = 0.63). However, 30% of patients in the CTX+GCSF group experienced febrile neutropenia. Regarding the transplant outcome, CTX+GCSF group showed faster neutrophil engraftment (median of 10 vs. 11 days) but there is no survival difference between the two groups.
Conclusions:
GCSF plus plerixafor mobilization achieved excellent success rate of stem cell collection with a lower risk of febrile neutropenia and much shorter length of stay. Addition of Plerixafor to GCSF improves stem cell collection without added toxicities.
