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Title: Peripheral blood stem cell mobilisation with G-CSF alone versus G-CSF and cyclophosphamide after bortezomib, cyclophosphamide and dexamethasone induction in multiple myeloma.
Austin Authors: Chua, Chong Chyn ;Lim, Hui Yin;Chai, Khai Li;Ong, Jeremy;Sim, Shirlene;Wood, Colin;Dickinson, Michael;Campbell, Philip;Hempton, Jennifer;King, Hayley;Dowsing, Claire;Bergin, Krystal;Muir, Sharon;Gibbs, Simon;Grigg, Andrew P 
Affiliation: Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
Clinical Haematology, St Vincent's Health, Fitzroy, Victoria, Australia
Integrated Haematology Department, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, Victoria, Australia
The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
Clinical Haematology, Cancer Services Barwon Health- University Hospital, Geelong, Victoria, Australia
Deakin University School of Medicine, Geelong, Victoria, Australia
Clinical Haematology, Alfred Health-Monash University, Clayton, Victoria, Australia
Department of Haematology, Monash University Eastern Health Clinical School, Clayton, Victoria, Australia
Issue Date: Sep-2018 2018-03-09
Publication information: Bone marrow transplantation 2018; 53(9): 1116-1123
Abstract: Bortezomib-based induction is often used in transplant-eligible patients with myeloma. The optimal peripheral blood stem cell (PBSC) mobilisation strategy in this context is unclear. We reviewed the efficacy of G-CSF alone (G-alone) vs. G-CSF and cyclophosphamide (G-cyclo: standard dose: 1.5-2 g/m2; high dose: 3-4 g/m2) PBSC mobilisation strategies in 288 patients who only received bortezomib, cyclophosphamide and dexamethasone (VCD) induction prior to autograft across six apheresis centres from November 2012 to June 2017. 'Uncomplicated successful mobilisation' was defined as achieving a PBSC yield of ≥4 × 106/kg within two aphereses, without plerixafor or mobilisation-associated toxicity (predominantly febrile neutropenia, FN). Success rates were 84% in G-cyclo standard dose (6% FN), 64% in G-cyclo high dose (18% FN) and 69% in G-alone (plerixafor successfully salvaged 8/9 patients). Median total stem cell yield was significantly higher with G-cyclo, but not different between the two cyclophosphamide doses. Age greater than the median of 61 years was associated with higher failure rates (22 vs. 11%, p = 0.01) and lower PBSC yield, especially in the G-alone group. Prior radiotherapy exposure did not impact on collection success. Our observations suggest that both G-cyclo standard dose and G-alone are reasonable mobilisation strategies. The former may be preferred if salvage plerixafor is unavailable.
DOI: 10.1038/s41409-018-0152-2
ORCID: 0000-0002-2162-3288
PubMed URL: 29523889
Type: Journal Article
Appears in Collections:Journal articles

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