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Title: The association of mobilising regimen on immune reconstitution and survival in myeloma patients treated with bortezomib, cyclophosphamide and dexamethasone induction followed by a melphalan autograft.
Austin Authors: Rees, Matthew J ;Mollee, Peter;Ng, Jun Yen;Murton, Alex;Gonsalves, Jose Filipe;Panigrahi, Ashish;Beer, Hayley;Loh, Joanna;Nguyen, Philip;Hunt, Sam;Jina, Hayden;Wayte, Rebecca;Sutrave, Gaurav;Tan, Jocelyn;Abeyakoon, Chathuri;Chee, Ashlyn;Augustson, Bradley;Kalro, Akash;Lee, Cindy;Agrawal, Shivam;Churilov, Leonid ;Chua, Chong Chyn ;Lim, Andrew Boon Ming ;Zantomio, Daniela ;Grigg, Andrew P 
Affiliation: Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
Department of Haematology, Princes of Wales Hospital, Sydney, NSW, Australia
Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
Department of Haematology, Eastern Health, Melbourne, VIC, Australia
Department of Clinical Haematology, Westmead Hospital, Sydney, NSW, Australia
Department of Haematology, University Hospital Geelong, Geelong, VIC, Australia
Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia
Clinical Haematology
Department of Haematology, Princess Alexandra Hospital, and School of Medicine, University of Queensland, Brisbane, QLD, Australia
Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
Issue Date: Sep-2021
Date: 2021-04-28
Publication information: Bone Marrow Transplantation 2021; 56(9): 2152-2159
Abstract: G-CSF only mobilisation has been shown to enhance immune reconstitution early post-transplant, but its impact on survival remains uncertain. We undertook a retrospective review of 12 transplant centres to examine overall survival (OS) and time to next treatment (TTNT) following melphalan autograft according to mobilisation method (G-CSF only vs. G-CSF and cyclophosphamide [CY]) in myeloma patients uniformly treated with bortezomib, cyclophosphamide and dexamethasone induction. Six centres had a policy to use G-CSF alone and six to use G-CSF + CY. Patients failing G-CSF only mobilisation were excluded. 601 patients were included: 328: G-CSF + CY, 273: G-CSF only. Mobilisation arms were comparable in terms of age, Revised International Staging System (R-ISS) groups and post-transplant maintenance therapy. G-CSF + CY mobilisation generated higher median CD34 + yields (8.6 vs. 5.5 × 106/kg, p < 0.001). G-CSF only mobilisation was associated with a significantly higher lymphocyte count at day 15 post-infusion (p < 0.001). G-CSF only mobilisation was associated with significantly improved OS (aHR = 0.60, 95%CI 0.39-0.92, p = 0.018) and TTNT (aHR = 0.77, 95%CI 0.60-0.97, p = 0.027), when adjusting for R-ISS, disease-response pre-transplant, age and post-transplant maintenance therapy. This survival benefit may reflect selection bias in excluding patients with unsuccessful G-CSF only mobilisation or may be due to enhanced autograft immune cell content and improved early immune reconstitution.
DOI: 10.1038/s41409-021-01300-2
ORCID: 0000-0001-8360-2952
Journal: Bone Marrow Transplantation
PubMed URL: 33911199
Type: Journal Article
Appears in Collections:Journal articles

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