A prospective, multicenter study on hematopoietic stemcell mobilization with cyclophosphamide plus granulocyte colony-stimulating factor and 'on-demand' plerixafor in multiple myeloma patients treated with novel agents.

Autor:	Mina R; Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino. roberto.mina@unito.it., Petrucci MT; Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome., Bonello F; Medical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo., Bongarzoni V; U.O.C. Ematologia, Azienda Ospedaliera 'San Giovanni/Addolorata', Roma., Saccardi R; Cellular Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence., Bertuglia G; Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino., Mengarelli A; Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome., Spadaro A; Division of Hematology, AOU Policlinico, University of Catania., Lisi C; Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome., Curci P; Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari., Lemoli RM; Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy; IRCCS Policlinico San Martino, Genova., Ballanti S; Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia, localita Sant'Andrea delle Fratte, Perugia., Floris R; S.C. Ematologia e CTMO, Ospedale Oncologico 'A. Businco', Cagliari., Cupelli L; Department of Hematology, S. Eugenio Hospital, Rome., Tosi P; Hematology Unit, Infermi Hospital, Rimini., Olivieri A; Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona., Rota-Scalabrini D; Medical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo., Cangialosi C; U.O.C. Ematologia, A.O. Ospedali Riuniti Villa Sofia-Cervello, Palermo., Nozzoli C; Cellular Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence., Anaclerico B; U.O.C. Ematologia, Azienda Ospedaliera 'San Giovanni/Addolorata', Roma., Fazio F; Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome., Bruno B; Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino., Mancuso K; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia 'Seragnoli', Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Universita di Bologna, Bologna., Corradini P; Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Universita di Milano, Milano., Milone G; Division of Hematology, AOU Policlinico, University of Catania., Boccadoro M; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino.
Jazyk:	angličtina
Zdroj:	Haematologica [Haematologica] 2024 May 01; Vol. 109 (5), pp. 1525-1534. Date of Electronic Publication: 2024 May 01.
DOI:	10.3324/haematol.2023.284023
Abstrakt:	High-dose melphalan plus autologous stem cell transplantation (ASCT) is a standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM), and adequate hematopoietic stem cell (HSC) collection is crucial to ensure hematologic recovery after ASCT. In this prospective, observational study we evaluated HSC mobilization with granulocyte colony-stimulating factor (G-CSF), cyclophosphamide, and 'on-demand' plerixafor (in patients with <20×106 CD34+ cells/L after at least 4 days of G-CSF or failing to collect ≥1×106 CD34+ cells/kg after the first apheresis) in NDMM patients treated with novel agent-based induction therapy. The primary endpoint was the rate of poor mobilizers (patients collecting <2×106 CD34+ cells/kg or requiring plerixafor rescue to reach an adequate HSC harvest). Secondary endpoints included the rate of patients collecting ≥2×106 CD34+ cells/kg after plerixafor administration and the identification of factors predicting mobilization failure or plerixafor need. Overall, 301 patients (median age 60 years) were enrolled. Two hundred and eighty-seven of 301 (95%) and 274 of 301 (93%) patients collected ≥2×106 and ≥4×106 CD34+ cells/kg, respectively, with a median of 9.9×106 CD34+ cells/kg collected. Poor mobilizers were 48 of 301 (16%): 34 of 301 (11%) required plerixafor rescue, and 14 of 301 (5%) failed HSC collection regardless of plerixafor. Thirty-four of 38 (90%) patients receiving plerixafor collected ≥2×106 CD34+ cells/kg. Bone marrow plasmacytosis at diagnosis >60% (odds ratio [OR]=4.14), lenalidomide use (OR=4.45), and grade 3-4 hematologic toxicities during induction (OR=3.53) were independently associated with a higher risk of mobilization failure or plerixafor need. Cyclophosphamide plus G-CSF and 'on-demand' plerixafor is an effective strategy in NDMM patients treated with novel agents, resulting in a high rate of HSC collection and high HSC yield (clinicaltrials gov. identifier: NCT03406091).
Databáze:	MEDLINE
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