Hematopoietic Progenitor Cell (HPC) Mobilization after Initial Therapy of Multiple Myeloma Including Velcade: Ability to Collect HPC as a Function of Velcade Dosing.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2884-2884 ◽  
Author(s):  
Michele Cottler-Fox ◽  
David Holley ◽  
Linda Whigham ◽  
Julie Stover ◽  
Erik Rasmussen ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Median Number ◽  
Initial Therapy ◽  
Autologous Stem Cell Transplant ◽  
Hematopoietic Progenitor Cell ◽  
Cell Transplant ◽  
Platelet Recovery ◽  
Peripheral Blood Cd34 ◽  
Pbsc Mobilization

Abstract Bortezomib (Velcade) was recently approved by the US FDA for use as salvage therapy for patients with relapsed multiple myeloma (MM). We are conducting a clinical trial (Total Therapy 3) using VDT-PACE (velcade 1.0 mg/m2, dexamethasone 40 mg po QD day4–7, thalidomide 200 mg po QHS day 4–7, and continuous infusion of cisplatin 10 mg/m2, doxorubicin 10 mg/m2, and etoposide 40 mg/m2 day 4–7) and G-CSF at 5-8 mcg/Kg sc BID for initial therapy of MM as well as for mobilization of HPC for collection and use in autologous stem cell transplant. Initially, 20 patients (pts) were enrolled in 6 cohorts involving an escalating number of bortezomib doses: cohort 1 (5 pts) had 2 doses with cycle 1 and then underwent HPC collection; cohort 2 (3pts) had 3 doses with cycle 1 and then collection; cohort 3 (3 pts) had 4 doses with cycle 1 and then collection; cohort 4 (3 pts) had 4 doses with cycle 1, 2 doses with cycle 2 and then underwent HPC collection; cohort 5 (3 pts) had 4 doses with cycle 1 and 3 doses with cycle 2 and then collection; cohort 6 (3pts) had 4 doses with cycle 1 and 4 doses with cycle 2 and then collection. Further pts (cohort 7) were then treated and underwent HPC collection as for cohort 6. The protocol required a minimum of 2 HPC collections, and all patients underwent large volume leukapheresis using a Cobe Spectra when the peripheral blood CD34 measured by ProCount™ predicted a collection of ≥ 1 x 106/kg (Hematology (ASH Educat Progr) 2003; 419–37). HPC product contamination with malignant plasma cells was done using flow cytometry for cytoplasmic immunoglobulins (cIg). Patients who failed to mobilize adequately to support a tandem transplant were enrolled on a study utilizing G-CSF+AMD3100 for mobilization. HPC Collections by Cohort # Pts median # Collections (range) mean CD34x106/Kg (range) *1pt died before collection #1 pt switched to AMD3100 +6 pts switched to AMD3100 Cohort 1 5 2 31.2 (19.8–47.8) Cohort 2 3* 2 52.4 (45.1–59.6) Cohort 3 3 2 45.3 (31.9–80.5) Cohort 4 3 2 (2–3)# 22.9 (5.9–40.9) Cohort 5 3 2 (2–4) 44.8 (18.2–85.5) Cohort 6 3 2 (2–3) 36.1 (22.6–47.1) Cohort 7 24 3 (0–9)+ 17.5 (0–30.8) The median number of HPC collections for the first 6 cohorts overall was 2, and contamination as judged by cIg was very rare (2 of 19 who underwent collection). However, while 1 pt in cohort 4 failed to mobilize adequately with the planned regimen and required transfer to the secondary mobilization study, 6 of the first 24 pts in cohort 7 failed to mobilize and also required transfer to the secondary mobilization study. Of the first 27 patients evaluable after first transplant, both granulocyte and platelet recovery proceeded promptly. Because of the apparent dampening of cycle 2 PBSC mobilization, future patients are mobilized during cycle 1. Incorporation of Velcade into PBSC mobilization regimens should therefore proceed with caution.

Hematopoietic Progenitor Cell (HPC) Collection Is Feasible in Previously Transplanted Multiple Myeloma Patients and Plerixafor Improves Collection

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4127-4127
Author(s):  
Xenofon Papanikolaou ◽  
Lisa Tyler ◽  
Bart Barlogie ◽  
Michele Cottler-Fox
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Median Time ◽  
Progenitor Cell ◽  
Median Number ◽  
Hematopoietic Progenitor Cell ◽  
Cell Transplant ◽  
Hematopoietic Progenitor ◽  
Platelet Recovery ◽  
Cd34 Cells

Abstract Abstract 4127 Autologous hematopoietic progenitor cell transplant (aHPCT) as salvage treatment in relapse is a therapeutic modality proven to induce response and improve overall survival (OS) in Multiple Myeloma (MM). However, many previously transplanted MM patients who might benefit from this intervention no longer have cryopreserved stem cells in storage. For these patients, it is important to know if HPC can be collected again adequate to support further aHPCT. Records of MM patients treated at the Myeloma Institute for Research and Therapy (MIRT), University of Arkansas for Medical Sciences, between 06/22/2005 – 11/16/2011 were reviewed to identify patients undergoing attempted remobilization following at least one previous aHPCT. HPC collection was performed using a Spectra (TerumoBCT) apheresis device to perform large volume leukapheresis (30L processed). Collection was guided by our predictive formula (Rosenbaum ER et al., Cytotherapy 2012;14(4) :461–6) and was continued until the collection goal was met or the daily collection contained less than 0.5×106 CD34+ cells/kg. We identified 48 patients (median age 58, range 38–82) who underwent at least one HPC collection, for a total of 98 collections (19 patients underwent one collection, 17 two collections, 6 three collections, 3 four collections, 3 five collections). The median time from previous APSCT was 3.25 years (range 0–8.8). Mobilization regimen information was available in all collections but two (Table 1). Plerixafor (Mozobil®) was used in 34 patients, for a total of 44 collections. For the total cohort of patients the median number of CD34+ cells per collection was 3.15×106 CD34+ cells/kg (0.1– 21.56), with a median of 4 days for each collection (1–10). No statistically significant correlation was seen for age, sex, number of previous aHPCT, time elapsed from previous aHPCT, or chemotherapy regimen used for previous aHPCT relative to the number of CD34+ cells collected. While the median number of CD34+ collected cells with or without plerixafor did not differ significantly (3.15 vs. 3.35×106 CD34+ cells/kg, p=0.701), the addition of plerixafor yielded a statistically significant increase if there was a poor previous mobilization (1.73 vs. 2.94×106 CD34+ cells/kg, p=0.004). Of 48 patients collected, 30 then underwent a subsequent aHPCT. Of these, 16 received cells procured after an aHPCT and 14 with cells procured prior to an aHPCT. No treatment related mortality was recorded in these aHPCT. Median number of CD34+ infused cells was 5.12×106 CD34+ cells/kg and 4.70×106 CD34+ cells/kg (p=0.583) for the before and after aHPCT procured stem cells. Median time for neutrophil engraftment (>500/mm3) was 10 days in both (p=0.897). Median time for platelet engraftment >20.000/mm3 was 12 and 11 days respectively (p=0.234), while for platelet engraftment >50.000/mm3 it was 24 and 15 days, with the difference being statistical significant (p=0.035). Nevertheless, all patients but one eventually achieved adequate platelet recovery (>100.000/mm3). In conclusion, collection of CD34+ cells following aHPCT is feasible and the addition of plerixafor can yield enough cells for a subsequent aHPCT even in cases where the initial attempt failed. HPC collected after a previous aHPCT provide a safe graft for another transplant. Table 1 Mobilization Type Number of Collections CD34+ cells×106/kg Median (range) Days for each collection median (range) Chemotherapy+G-CSF 30 3.19 (0.25–16.7) 4 (2–10) Chemotherapy+G–CSF +plerixafor 7 4.51 (1.68–11.98) 5 (2–7) G–CSF+/–GM–CSF+/–Epo 23 2.69 (0.52–16.93) 3 (3–5) G–CSF+plerixafor 36 2.84 (0.1–16.45) 4 (1–5) Disclosures: No relevant conflicts of interest to declare.

scholarly journals Daratumumab, Pomalidomide, and Dexamethasone (DPd) for the Treatment of Relapsed/Refractory Multiple Myeloma: A Single Institution Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5642-5642 ◽  
Author(s):  
Al-Ola Abdallah ◽  
Neil Dunavin ◽  
Brian McClune ◽  
Leyla Shune ◽  
Ajoy L. Dias ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proteasome Inhibitor ◽  
Research Funding ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Duration Of Treatment ◽  
Effective Treatment Option ◽  
Refractory Multiple Myeloma ◽  
Overall Response

Abstract Background: Daratumumab triplet regimens containing dexamethasone and lenalidomide or bortezomib are an effective treatment option for patients with relapsed/refractory multiple myeloma (RRMM). Daratumumab was recently FDA-approved in combination with the second-generation immunomodulatory drug, pomalidomide, and dexamethasone based (DPd) on results of the EQUULEUS study where overall response rates (ORR) of 60% were seen. The goal of this retrospective study was to analyze clinical outcomes of the DPd triplet regimen in either a daratumumab and pomalidomide naïve or refractory population of heavily pretreated RRMM patients at our institution. Methods: Thirty-two patients with RRMM treated with DPd at the University of Kansas Health System between November 2015 and July 2018 were included in our analysis. DPd consisted of 28-day cycles of daratumumab 16 mg/kg intravenously (weekly for cycles 1 and 2, every 2 weeks for cycles 3-6, and every 4 weeks thereafter until disease progression); pomalidomide 4 mg orally (PO)on Days 1-21 and adjusted for cytopenia or toxicities; and dexamethasone 40 mg PO weekly adjusted based on tolerance. based on age. Responses were evaluated using IMWG criteria. Patient characteristics, disease course, and outcomes were summarized with descriptive statistics. Kaplan-Meier analyses were used to estimate progression-free (PFS) and overall survival (OS). Results:The median age was 64 years (range 44-83). Twenty-three patients (72%) had IgG isotype, 11 patients (34 %) had ISS stage III disease at diagnosis, 13 patients (41%) had high risk cytogenetics, and 13 patients (41%) had extramedullary disease. Median number of previous lines of therapy was 4 (1-9). Twenty-two patients (69%) received ≥3 prior therapies. Twenty-three patients (72%) were proteasome inhibitor refractory, 28 patients (88%) were immunomodulator refractory, 9 patients (28%) were daratumumab refractory, and 3 patients (15%) were double refractory to daratumumab and pomalidomide. Twenty-eight patients (88%) had received autologous stem cell transplant (ASCT) prior to DPd; 12 patients (38%) had ≥2 prior transplants. Median number of DPd cycles received was 6 (2-30) and the median duration of treatment was 5 months (2-30). At a median follow-up of 8.4 months (range: 2-29), the overall response rate (ORR) for all patients was 72% which compares favorably to the ORR of 60% in the EQUULEUS study. However, about half of the responses were partial responses (PR) (47%). The ORR rate for those who were refractory to either pomalidomide or daratumumab was 65%. The PFS was 8.3 months, while the median OS was not reached. Conclusion: DPd was recently approved for the treatment of RRMM. Our ORR compares favorably to the EQUULEUS study, however about half of responses were partial responses or better. Surprisingly, our analysis shows an impressive ORR in patients with previous exposure to proteasome inhibitor and immunomodulatory therapies in RRMM population, suggesting a benefit of DPd even in patients who received prior pomalidomide or daratumumab. Disclosures McGuirk: Astellas Pharma: Research Funding; Gamida Cell: Research Funding; Novartis Pharmaceuticals Corporation: Honoraria, Other: speaker, Research Funding; Pluristem Ltd: Research Funding; Kite Pharma: Honoraria, Other: travel accommodations, expenses, speaker ; Fresenius Biotech: Research Funding; Bellicum Pharmaceuticals: Research Funding. Ganguly:Daiichi Sankyo: Research Funding; Janssen: Consultancy; Amgen: Consultancy; Seattle Genetics: Speakers Bureau.

Weekly Cyclophosphamide and Alternate Day Prednisone: An Effective, Convenient and Well Tolerated Treatment for Relapsed Multiple Myeloma Following Autologous Stem Cell Transplant.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4917-4917
Author(s):  
A. Keith Stewart ◽  
Young Trieu ◽  
Suzanne Trudel ◽  
Greg Pond ◽  
Joseph Mikhael ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Median Time ◽  
Stem Cell Transplant ◽  
Alkylating Agents ◽  
Progression Free Survival ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Protein Reduction

Abstract Alkylating agents remain among the most potent therapies available for treatment of Multiple Myeloma (MM). Their use prior to, or following, autologous stem cell transplant (ASCT) is, however, compromised by concerns about stem cell quality and by myelosuppression limiting effective dose delivered. To address this concern we have studied a combination of cyclophosphamide 500 mg p.o. once weekly and prednisone 100 mg p.o. on alternate days in 66 patients requiring salvage therapy post-ASCT. Dose reductions were allowed for toxicity beginning at cycle 2. On an intent to treat basis, 66 patients received this regimen, however, 7 of these patients were not fully evaluable for response due to non-secretory disease. Of the 59 patients evaluable for response, the median time from transplant to treatment was 26.4 months (range, 6.0 to 66.6). The median time from post-transplant relapse to start of cyclophosphamide and prednisone (C/P) therapy was 1.4 months. The median number of therapies from time of diagnosis to C/P initiation was 2 (range, 1.0 to 5.0). At the date of analysis, treatment with C/P is ongoing in 12 (20.3%) patients, with a median duration of 3.6 months (range, 1.9 to 11.6). The 47 patients who have completed C/P therapy were treated for a median time of 5.5 months (range, 0.5 to 21.7). The reason for discontinuation among these 47 patients included disease progression (42.6% of patients discontinued), plateau disease (21.3%), receiving a second transplant (17.0%), toxicity (10.6%), or switched to another regimen (8.5%). A partial response (>50% protein reduction) was obtained in 37.3% of patients, 18.6% attained minimal response (25–50% protein reduction), 33.8% patients stable disease, while 10.2% patients had progressed on treatment. The estimated median (95% CI) months of progression-free survival after start of C/P treatment is 14.9 (8.7, 21.7). Twenty-three (38.9%) of patients have relapsed after C/P treatment, a median (range) of 8.7 (0.5–65.7) months after start of C/P treatment. At 6 months 74.3% (95% C.I. 61.9% – 89.1%) of patients were progression-free with 28% (95% CI: 16.1–49.2%) progression free at two years. At time of analysis, 44 (74.6%) patients are still alive, with a median follow up of 10.6 months (range, 1.2 to 65.7) since the start of C/P therapy. Fifteen patients have died at a median 13.0 months (range, 1.4 to 61.7) since the time of C/P initiation. The median overall survival (95% C.I.) is estimated to be 35.9 months (24.2, NA). These results demonstrate that the combination of oral cyclophosphamide and prednisone is an effective (56% MR or PR), very well tolerated (10% discontinued due to toxicity) and convenient treatment as salvage MM therapy post-ASCT. The relative lack of myelosuppression allows for re-collection of stem cells and salvage transplant while retaining other active second line agents for later relapse. This regimen thus compares favorably with recent salvage therapeutics introduced in MM and is now being studied in combination with these newer active agents and in induction therapy.

Chromosome 1p21 Deletion Defines a Subgroup of Multiple Myeloma with Poor Clinical Outcomes Independent of del (13q), del(p53), t(4;14) or 1q21 Amplification.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2475-2475
Author(s):  
Hong Chang ◽  
Connie Qi ◽  
Allan Jiang ◽  
Wei Xu ◽  
Trieu Young ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Risk Factor ◽  
Genetic Risk ◽  
Plasma Cells ◽  
Prognostic Significance ◽  
Suppressor Gene ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Median Percentage ◽  
Chromosome 1Q

Abstract Amplifications involving chromosome 1q and deletions involving 1p are frequent events in multiple myeloma (MM). The pathogenesis and clinical significance of these anomalies is largely unknown but CKS1B amplification at 1q21 detected in 30–40% of MM patients is associated with disease progression. As karyotyping and SNP based mapping analysis identify a minimal common deletion region involving the 1p21 locus, we used FISH combined with cytoplasmic light chain detection (cIg-FISH) to investigate the prevalence and prognostic significance of del(1p21) in a cohort of 186 MM patients undergoing autologous stem cell transplant. CIg-FISH detected hemizygous 1p21 deletions in 18% of the cases. The median percentage of clonal plasma cells harboring del(1p21) was 55% (range 20–95%). The presence of 1p21 deletions was strongly correlated with CKS1B amplification (p=0.004), t(4;14) (p= 0.027), and del(p53) (p=0.04), but not with del(13q) or t(11;14). There was no association between del (1p21) and other biological factors including age, gender, Hb, albumin, C-reactive protein, beta-2 microglobulin level, isotype or bone marrow plasmacytosis. Patients with 1p21 deletions had significantly shorter progression-free (median 10.5 vs. 25.4 months, p=0.0001) and overall survivals (median 33.9 months vs. not reached, p=0.001) than those without such deletions. On multivariate analysis, del(1p21) was an independent risk factor for progression free (p< 0.0001) and overall survivals (p=0.0005) after adjusting for other genetic risk factors including del(13q), del(p53), t(4;14) and CKS1B amplification. Our results indicate that del(1p21) is a novel genetic risk factor and warrant inclusion of this genetic aberration in the risk-stratification of MM. Further studies are required to identify candidate tumor suppressor gene(s) at the 1p21 locus and explore their role in the molecular pathogenesis of MM.

Trends in First Line Prescribing Preferences Among US-Based Hematology-Oncology Physicians for Patients with Multiple Myeloma Who Are Not Candidates for or Elect Not to Undergo Stem Cell Transplant

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5776-5776
Author(s):  
Joel H Schwartz ◽  
Joanne Willey ◽  
Arden Buettner ◽  
Mitch Scharf ◽  
Maria Lankford ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Standard Of Care ◽  
Initial Therapy ◽  
Fish Analysis ◽  
Cell Transplant ◽  
Audience Response ◽  
Case Scenario ◽  
Non Hodgkin Lymphoma ◽  
New Diagnosis

Abstract Background: Doublet therapy or melphalan containing regimens have been the standard of care for the 1st line treatment of patients with multiple myeloma (MM) who are not transplant candidates due to advanced age, poor PS, comorbidities or a desire not to undergo transplant. However, recently there has been an increase in the preference for non-melphalan containing triplet therapy among this population. Prescribing preferences (PPrefs) may be influenced by multiple considerations such as randomized efficacy data, cross trial comparisons of efficacy and toxicities, co-morbid conditions, ease of access to and administration/management of specific agents, cumulative patient out of pocket costs, patient compliance, and physician familiarity with available agents. Methods: PPrefs were assessed through a validated, proprietary, live, case-based market research tool (Challenging Cases®). Assessments of 1348 US based hematology-oncology physicians (HOPs) were conducted from 2011-2014. Data were acquired using blinded, audience-response technology. All responses were obtained contemporaneously prior to any display of respondent selections. The case scenario involved a 74 year old male with total globulin level 9.2 gms, 40% plasma cells in bone marrow, no cytogenetic abnormalities on FISH analysis. White blood cell count (WBC) 5,700; Hemoglobin (Hgb) 9.7 gms; Platelets (Plts) 214K; 500 mg kappa light chains/24 hours via 24 hour urine. The patient did not wish to consider transplant. U.S. HOPs were asked what they would prescribe as 1st line therapy for the patient in this scenario. Results: 1st line PPrefs by yearAbstract 5776. Table 11st line preference74 yo, newly diagnosed patient2011 N=3542012 N=3712013 N=3672014 N=256Bortezomib IV* ± dexamethasone24%8%5%3%Bortezomib SC** ± dexamethasonen/a16%21%23%Lenalidomide + dexamethasone26%20%24%26%RVd (lenalidomide, bortezomib, dexamethasone)20%31%30%33%CyBorD (cyclophosphamide, bortezomib, dexamethasone)2%2%4%8%Melphalan-based regimen22%20%16%6%Other6%3%2%1% * Intravenous ** Subcutaneous Use of doublets remains at about 50%, albeit with a shift away from IV bortezomib to the SQ route.Use of non melphalan triplets almost doubles from 2011 to 2014 (22% to 41%). This is accompanied by a decline in the use of a melphalan based regimen, from 22% to 6%. Conclusions: Although approximately 50% of US-based HOPs still use a non melphalan doublet in non-SCT eligible pts presenting with a new diagnosis of multiple myeloma, the remaining 50% of physicians appear to be progressively shifting towards use of non-melphalan containing triplet combinations, such as RVd and CyBorD, as initial therapy. During the same time period, a corresponding decline in the PPref for melphalan is seen in this patient population. Additionally, bortezomib administration via the IV route has been replaced almost entirely by preference for the SC route in those treating with a bortezomib doublet. Disclosures Off Label Use: Clofarabine is not FDA-approved for non-Hodgkin lymphoma.

Factors that predict successful remobilization after autologous hematopoietic progenitor cell transplant (aHCT) for multiple myeloma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8610-8610
Author(s):  
Xenofon Dimitrios Papanikolaou ◽  
Eric Rosenbaum ◽  
Lisa Tyler ◽  
Bart Barlogie ◽  
Michele Cottler-Fox
Keyword(s):  
Multiple Myeloma ◽  
Progenitor Cell ◽  
Median Number ◽  
Therapeutic Modality ◽  
Hematopoietic Progenitor Cell ◽  
Cell Transplant ◽  
Hematopoietic Progenitor ◽  
Storage Methods ◽  
Treatment Related Mortality ◽  
Related Mortality

8610 Background: aHCT is a proven therapeutic modality in treating relapsed multiple myeloma (MM). However, previously transplanted patients may have no hematopoietic progenitor cells (HPC) left in storage. Methods: Collection of HPC after aHCT was studied in 221 MM patients who underwent 333 mobilization attempts between 10/2000 and 06/2012. Results: The median number of CD34+ collected was 4.7 ×106/kg, with 74% of collections yielding at least 2.5×106/kg. Mobilization with chemotherapy and G-CSF was most efficient, yielding a median of 6.84×106/kg (p<0.001). Growth factor-only mobilization was least effective, with a median of 3.01×106/kg (p<0.001). The addition of plerixafor yielded a significant increase if there was a previous “poor” (<2.5×106/kg) collection (1.83 vs. 3.43×106/kg, p<0.001). In univariate statistical analysis female sex (p=0.048), platelets (PLT) ≤100×106/L (p<0.001), hemoglobin ≤11g/dL (p=0.032), and albumin ≤3.5 g/dL (p=0.003) prior to mobilization correlated with a “poor” collection. In multivariate analysis only PLT ≤100×106/L was significant (p<0.001). Of the 221 patients collected, 154 underwent subsequent aHCT. Infusion of HPC procured after previous aHCT did not yield a difference in treatment-related mortality (p=0.766). Use of only cells collected after aHCT was related to a delayed platelet engraftment ≥50×106/L (p<0.001). Conclusions: Remobilization and collection of an adequate number of HPC after previous aHCT is feasible. PLT ≤100×106/L suggest the need for plerixafor for a successful collection. Infusion of the graft procured is safe and effective, but use of only cells collected after aHCT is associated with delayed platelet engraftment >50×106/L.

Stem Cell Transplant without Growth Factor In Multiple Myeloma: Engraftment Kinetics, Bacteremia, and Hospitalization.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3469-3469
Author(s):  
Morie Abraham Gertz ◽  
Dennis Gastineau ◽  
Martha Lacy ◽  
Angela Dispenzieri ◽  
Suzanne R. Hayman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Growth Factors ◽  
Growth Factor ◽  
Research Funding ◽  
Stem Cell Transplant ◽  
The United States ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant

Abstract Abstract 3469 Introduction: Stem cell transplantation is important in the management of multiple myeloma. In the United States, the standard of care is administration of growth factors to accelerate neutrophil recovery after stem cell transplant. The need for growth factors after transplant has not been investigated recently. Patients: We analyzed a cohort of 166 patients at our institution who underwent autologous transplant for multiple myeloma without receiving growth factors after transplant and compared them with 498 patients who received standard filgrastim beginning on posttransplant day 5. TABLE Results: A neutrophil count of 500/μL was achieved in a median of 12.5 days in patients receiving growth factor, compared with 13.5 days in those not receiving growth factor (P<.001) Fig 1. Platelet engraftment was identical (median, 14.5 days; P=.12) in both groups, despite a lower median number of CD34+ cells infused in patients who did not receive growth factors. Incidence of nonstaphylococcal bacteremia was identical in both groups. The median hospital stay was 3.5 days shorter in the group not receiving growth factor. Bacteremia impacted platelet but not neutrophil engraftment. Figure 2 Conclusion: It is feasible and reasonable to perform autologous stem cell transplant for multiple myeloma without administering growth factors. Estimated savings would be $4,600 for each transplanted patient. Growth factor administration is not required for a safe outcome and decreases the number and severity of some of the fluid-related complications after transplant such as acute respiratory distress syndrome, allergic reactions, alveolar hemorrhage, and rarely splenic rupture. Disclosures: Gertz: Celgene: Honoraria; Millenium: Honoraria, Membership on an entity's Board of Directors or advisory committees. Lacy:Celgene: Research Funding. Dispenzieri:Celgene: Honoraria, Research Funding; Binding Site: Honoraria. Kumar:Celgene: Consultancy, Research Funding; Millennium: Research Funding; Merck: Consultancy, Research Funding; Novartis: Research Funding; Genzyme: Consultancy, Research Funding; Cephalon: Research Funding.

Absolute Lymphocyte Count As Predictor of Overall Survival for Patients with Multiple Myeloma Treated with Single Autologous Stem Cell Transplant: Experience of a Single Centre,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4121-4121
Author(s):  
Victor H Jimenez-Zepeda ◽  
Donna E. Reece ◽  
Suzanne Trudel ◽  
Christine Chen ◽  
Norman Franke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Lymphocyte Count ◽  
Research Funding ◽  
Stem Cell Transplant ◽  
Plasma Cells ◽  
Absolute Lymphocyte Count ◽  
Autologous Stem Cell Transplant ◽  
Peripheral Blood Lymphocytes ◽  
Cell Transplant

Abstract Abstract 4121 Post-Autologous stem cell transplant (ASCT) studies have demonstrated that early absolute lymphocyte count (ALC) recovery is associated with prolonged survival in some hematological malignancies. Peripheral blood lymphocytes from Multiple Myeloma (MM) were shown to have direct anti-MM activity by proliferative and cytotoxic responses to autologous and allogeneic myeloma plasma cells Disclosures: Jimenez-Zepeda: J & J: Honoraria. Reece:Bristol, Meyers, Squibb: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Johnson&Johnson: Research Funding; Merck: Honoraria, Research Funding; Otsuka: Honoraria, Research Funding; Millennium: Research Funding; Amgen: Honoraria. Chen:Celgene Corporation: Consultancy, Honoraria, Research Funding. Kukreti:Celgene: Honoraria.

Autologous Stem Cell Transplant in Patients with Multiple Myeloma Previously Treated with Lenalidomide: A Single-Institution Experience Using An Intermediate-Dose Cyclophosphamide-Based Regimen

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4391-4391
Author(s):  
Asif Alavi ◽  
Rada Grubovic ◽  
Gary J. Schiller
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Treated Group ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Cd34 Cells ◽  
Peripheral Stem Cells

Abstract Abstract 4391 Background: High dose chemotherapy followed by autologous transplantation of peripheral blood stem cells plays an important role in the management of intermediate- and advanced-stage multiple myeloma. In order for successful engraftment to occur, adequate numbers of high quality peripheral stem cells must be harvested prior to transplantation. Mobilization of PBSC in patients treated with lenalidomide has been associated with poor apheresis collections after G-CSF mobilization. The purpose of this study is to present our institution’s experience utilizing an intermediate-dose cyclophosphamide-based mobilization regimen. Methods: We retrospectively analyzed data for patients with multiple myeloma who underwent autologous stem cell transplant at UCLA between 2006 and 2010. Data were obtained from the database of the UCLA Heme Malignancy/Stem Cell Transplant Unit, the electronic health record system and stem cell processing laboratory. All patients underwent mobilization with a regimen of cyclophosphamide 2.5g/m2 IVPB, G-CSF 10 mcg/kg/day for 4 days SQ, and prednisone 2mg/kg/day for 4 days po. The number of CD 34+ cells was used as a marker for the number of peripheral stem cells collected. Minimum dose collected to ensure adequate engraftment was 2×106/kg CD34+ cells. Patients were conditioned with melphalan 100mg/m2/d x2 (unless there was evidence of renal failure, in which case the dose was reduced to 100mg/m2) with subsequent infusion of stem cells. Neutrophil engraftment was defined as the first day of absolute neutrophil count greater than 500×106/L ≥ 7 days after transplant. Results: Autologous stem cell transplant was performed in 103 patients with multiple myeloma at UCLA between 2006 and 2010. Median number of apheresis procedures was 1 (1–12) with a median of 4.4×106/kg (1.4–33.5) CD34+ cells collected. Median time to engraftment was 10 (8–18) days. Thirty-five patients received lenalidomide at some point in their pretransplant treatment. Median number of apheresis procedures was 1 in both lenalidomide and non lenalidomide treated groups. In the lenalidomide treated group 54% required only one collection versus 75% in the non lenalidomide treated group (p=0.033). In the lenalidomide treated group 31% required 3 more or more collections versus 10% in non lenalidomide treated group (p=0.0075). Three patients in the lenalidomide group had subsequent mobilization with plerixafor with one of these requiring bone marrow harvesting. Median CD34+ cells collected was 3.5×106/kg and 4.9×106/kg (p=0.246) in the lenalidomide and non-lenalidomide groups respectively. Both groups had a median time to neutrophil engraftment of 10 days with a similar range. Conclusion: Pre-transplant use of lenalidomide adversely affected the number of stem cell apheresis procedures required to procure adequate stem cell dose as evidenced by a greater percentage requiring 3 or more collections. However, despite prior lenalidomide exposure, the use of our mobilization regimen permitted adequate collection, with the majority of patients requiring only one apheresis procedure, and led to an equivalent time to neutrophil recovery. Disclosures: Off Label Use: Cyclophosphamide and G-CSF for mobilization of stem cells.

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