Lenalidomide with Low-Dose Dexamethasone (Rd) Continuously Versus Rd Induction, Tandem MEL140 with Autologous Transplantation and Lenalidomide Maintenance: Planned Interim Analysis of a Prospective Randomized Trial in Patients 60-75 Years of Age with Multiple Myeloma

Abstract Background: Lenalidomide with low-dose dexamethasone (Rd) is an emerging treatment option for newly diagnosed multiple myeloma patients with higher age. However, many older patients also remain candidates for autologous transplantation especially with age-adjustment of high-dose melphalan. Potentially, high-dose therapy could add to the benefit of Rd, alternatively the effect of high-dose therapy could be more or less redundant in this setting. The DSMM XIII trial is a multicenter, open-label, phase III trial comparing the safety and efficacy of continuous Rd versus Rd induction followed by age-adjusted tandem high-dose melphalan with autologous transplantation and lenalidomide maintenance. Methods: Patients with newly diagnosed multiple myeloma with symptomatic and measurable disease of age 60-75 years were randomly assigned to either (A1) lenalidomide (25 mg po d1-21/28d) with low-dose dexamethasone (Rd) (40 mg po d1, d8, d15, d22/d28) for 3 cycles followed by stem cell mobilization and continued Rd until progression or (A2) 3 cycles of Rd, followed by stem cell mobilization, tandem high-dose melphalan 140 mg2 (MEL140) with autologous blood stem cell transplantation and lenalidomide maintenance 10 mg daily until progression. At randomization, patients were stratified according to age (≤70 years vs >70 years) and ISS stage (I, II vs III). Antithrombotic prophylaxis with low molecular weight (LMW) heparin or aspirin was recommended. The primary endpoint was progression-free survival (PFS), and secondary endpoints included safety, responses, overall survival and others. We report the results of the planned first interim analysis after occurrence of one third of events as pre-specified. Results: Since March 2010, 253 patients have been randomized and data of 251 patients were available for analysis. The median age was 68 years (range 59-75), 30% were older than 70 years, 34% had ISS stage I, 37% ISS stage II, and 29% ISS stage III. The median PFS for the whole study population (A1 and A2) was 37.3 months. The comparison of PFS by randomization arm did not meet the formal criteria for early termination of the trial. The overall response rate after 3 cycles of Rd (A1 and A2) was 75%, with 2% demonstrating complete response (CR), 21% very good partial response (VGPR) and 52% partial response (PR). A further 20% of patients had stable disease and 6% of patients progressive disease. The 3-year-survival rate is 75% (95% confidence interval, 68-84) for all patients and with respect to ISS stage amounted to 90% (CI: 81-99, ISS stage I), 78% (CI: 66-91, ISS stage II) and 51% (CI: 35-74, ISS stage III). For the two age groups, the 3-year-survival was 73% (CI: 64-84) in patients with age ≤70 years and 80% (CI: 68-94) in patients with age >70 years. So far, 8 (3%) second primary malignancies (SPM) were observed, 4 skin tumors and 4 other solid tumors, but no hematological SPM was documented. Conclusion: In our trial, lenalidomide with low-dose dexamethasone (Rd) was found to be associated with a favorable median progression-free survival at 3 years. The survival in patients >70 years was not inferior compared to younger patients. The potential advantages and disadvantages of combining lenalidomide with high-dose melphalan and autologous transplantation in comparison to continous Rd are addressed by this ongoing trial and further data will be presented at the meeting. Disclosures Straka: Celgene: Consultancy, Honoraria, Research Funding. Off Label Use: Lenalidomide for first-line treatment.

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High-Dose Melphalan Versus Busulfan, Cyclophosphamide As Conditioning Regimens for Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Blood ◽

10.1182/blood.v126.23.2001.2001 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2001-2001

Author(s):

Michael Styler ◽

Pamela Ann Crilley ◽

Maneesh Jain ◽

Kristine Ward ◽

David Topolsky ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Progression Free Survival ◽

High Dose Chemotherapy ◽

University Hospital ◽

High Dose ◽

Cell Transplant ◽

Free Survival ◽

Conditioning Regimens ◽

High Dose Melphalan

Abstract Introduction: Autologous stem cell transplantation after high dose chemotherapy has been shown to increase survival in patients with multiple myeloma. Studies have shown prolongation of median overall survival by 12 months. The standard conditioning regimen is high-dose Melphalan (HDM) at a dose of 200 mg/m2. Melphalan was shown to be superior to Thiotepa when given with total body irradiation. Other regimens include high dose Carboplatin with Etoposide and Cyclophosphamide or Cyclophosphamide, Carmustine and Etoposide. No regimen has shown marked superiority over others. Patients of I. Brodsky Associates at Hahnemann University Hospital were treated with autologous transplant with either high-dose Melphalan (HDM) or Busulfan and Cyclophosphamide (BuCy) as the conditioning regimens. To date, no studies comparing these two preparative regimens have been published. Thus the purpose of our chart review was to compare progression free survival of the two regimens. Hypothesis: The objective of the study is to determine if there is a difference in progression free survival and side effects in autologous stem cell transplant patients receiving either Melphalan or Busulfan and Cyclophosphamide as conditioning regimens. Methods: This study is a retrospective chart review of 94 patients, who underwent HSCT for multiple myeloma at Hahnemann University Hospital between December, 1989 and March, 2012. 47 patients received BuCy (Busulfan 16mg/kg and Cyclophosphamide 120mg/kg) and 49 patients received Melphalan 200 mg/m2. The primary end points were progression free survival (PFS) at 6 months, one year and overall PFS. Data was analyzed using the Kaplan Meier method with the WINKS SDA6 statistical software. Survival curves were compared using the Mantel-Haenszel comparison. Secondary study endpoints included safety profile. Results: Median age was 56 and 60 for the BuCy and HDM groups, respectively. The BuCy group had 68% males while the HDM group had 53% males. Patients in both groups received peripheral stem cell transplants with the exception of 4 in the BuCy group who had bone marrow transplants. As compared with BuCy, HDM treatment increased median progression free survival (37.3 vs. 18.1 months; P=0.014). There was a significantly higher rate of 6 month progression free survival (94% vs. 75%; P=.011) and 12 month progression free survival (82% vs 57%; P=0.006) in the HDM group compared to the BuCy group. The safety profile was as follows comparing BuCy and HDM, respectively: Moderate/severe mucositis (55% vs 48%), VOD (2 of 49 vs 1 of 47), hemorrhagic cystitis (2 of 49 vs. 1 of 47), infection within 100 days of transplant (28% vs 18%), mean peak T. Bilirubin ( 0.75 vs. 0.89), mean peak Alkaline phosphatase (127 vs. 90), mean peak AST (37.5 vs. 35), mean peak Cr (1.0 vs 1.2), mean days to ANC of 1000 (11.9 vs. 12.5), mean days to platelets > 20K (11.3 vs. 9.9), mean days to platelets > 50K (13.5 vs. 12.9). Conclusion: Our study showed that median progression free survival was longer with the HDM group compared to the BuCy group overall and at 6 and 12 months. Overall, patients treated with HDM had a median improvement in DFS of 1.5 years (37.3 months vs. 18.1 months, p=0.014). This data supports the use of HDM as the effective first line regimen for high dose chemotherapy and autologous stem cell transplant for patients with multiple myeloma. A limitation to our study is incomplete data regarding maintenance therapy post-transplant for the two groups. There was one patient in the BuCy group who relapsed at 236 months. Such prolonged disease free survival was not apparent in the HDM group but the median time to follow up for BuCy is longer by up to 13 years. BuCy was associated with more infections and more severe mucositis, while metabolic and hematologic toxicities were similar in both groups. Disclosures No relevant conflicts of interest to declare.

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Low-Dose Cyclophosphamide versus Intermediate-High-Dose Cyclophosphamide versus Granulocyte Colony-Stimulating Factor Alone for Stem Cell Mobilization in Multiple Myeloma in the Era of Novel Agents: A Multicenter Retrospective Study

Transplantation and Cellular Therapy ◽

10.1016/j.jtct.2020.12.009 ◽

2021 ◽

Author(s):

Beatrice Anna Zannetti ◽

Francesco Saraceni ◽

Claudia Cellini ◽

Elisabetta Fabbri ◽

Federica Monaco ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Retrospective Study ◽

Low Dose ◽

Stem Cell Mobilization ◽

High Dose ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Cell Mobilization ◽

Stimulating Factor

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Cyclophosphamide–bortezomib– dexamethasone compared with bortezomib–dexamethasone in transplantation-eligible patients with newly diagnosed multiple myeloma

Current Oncology ◽

10.3747/co.27.5385 ◽

2019 ◽

Vol 27 (2) ◽

Author(s):

A. Figueiredo ◽

H. Atkins ◽

R. Mallick ◽

N. Kekre ◽

A. Kew ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Progression Free Survival ◽

Newly Diagnosed ◽

Free Survival ◽

Tertiary Centre ◽

Depth Of Response ◽

Cell Mobilization ◽

Stimulating Factor ◽

Good Partial Response

Introduction Cyclophosphamide–bortezomib–dexamethasone (CyBorD) is considered a standard induction regimen for transplant-eligible patients with newly diagnosed multiple myeloma (mm). It has not been prospectively compared with bortezomib–dexamethasone (Bor-Dex). We aimed to compare the efficacy of CyBorD and Bor-Dex induction in transplant-eligible patients. Methods In a retrospective observational study at a single tertiary centre, all patients with transplant-eligible mm who received induction with CyBorD or Bor-Dex between March 2008 and April 2016 were enrolled. Progression-free survival (pfs), response, and stem-cell collection for a first autologous stem-cell transplantation (ahsct) were compared. Results Of 155 patients enrolled, 78 (50.3%) had received CyBorD, and 77 (49.7%), Bor-Dex. The patients in the Bor-Dex cohort were younger than those in the CyBorD cohort (median: 57 years vs. 62 years; p = 0.0002) and more likely to have had treatment held, reduced, or discontinued (26% vs. 14.5%, p = 0.11). The stem-cell mobilization regimen for both cohorts was predominantly cyclophosphamide and granulocyte colony–stimulating factor (gcsf). Plerixafor was used more often for the CyBorD cohort (p = 0.009), and more collection failures occurred in the CyBorD cohort (p = 0.08). In patients receiving Bor-Dex, more cells were collected (9.9×106 cells/kg vs. 7.7×106cells/kg, p = 0.007). At day +100, a very good partial response or better was achieved in 75% of the CyBorD cohort and in 73% of the Bor-Dex cohort (p = 0.77). Median pfs was 3.2 years in the Bor-Dex cohort and 3.7 years in the CyBorD cohort (p = 0.56). Conclusions Overall efficacy was similar in our patients receiving CyBorD and Bor-Dex. After ahsct, no difference in depth of response or pfs was observed. Cyclophosphamide–gcsf seems to increase collection failures and hospitalizations in patients receiving CyBorD. Prospective studies are required to examine that relationship.

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Autologous stem cell transplantation (ASCT) in AL amyloidosis: Feasibility outside national amyloidosis referral centers and proposal for simpler pre-transplant staging

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17545 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17545-17545

Author(s):

N. Jain ◽

M. Pasquini ◽

M. Paul ◽

P. Hari

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Hospital Stay ◽

Stage I ◽

High Dose ◽

Al Amyloidosis ◽

Cell Transplant ◽

Safe Procedure ◽

Hematological Response ◽

High Dose Melphalan

17545 Background: Single center data from national amyloidosis referral centers suggest that high dose melphalan based ASCT is an effective upfront treatment strategy for AL amyloidosis. Absence of published randomized control trials, referral bias and center experience make generalizability of this data difficult since data from outside of major referrals centers is limited. Pre-transplant staging is complicated by the profusion of articles describing various adverse risk factors. Methods: Retrospective review of bone marrow transplant database at our institution was conducted. All patients with AL amyloidosis who underwent ASCT were included in the study. We stratified patients based on International Staging System (ISS) for multiple myeloma. Organ and hematological response were assessed using 2005 consensus guidelines. Results: 13 patients (6 males) underwent ASCT for AL amyloidosis with risk adapted high dose melphalan dosing (melphalan mg/m2 100 (n = 1), 150 (n = 8) and 200 (n = 4)). Median age of the patient population was 53 years (range 31–75 years). Organ involvement was as follows - single organ = 6, 2 organs = 4 and 3 organs = 3. 4 patients had cardiac amyloidosis. 100 day transplant related mortality (TRM) was 15.3%. Overall survival was 84 % (95 % CI 51–96%) @ 1 yr and 75% (95% CI 38–91%) @ 2 yrs. Median follow up was 18 months. No deaths were observed >17 months post-transplant. 45 % patients had organ response. Complete hematological response was observed in 45 % patients. Mean duration of peri-transplant hospital stay for ISS stage I, II and III were 20.5 days (n = 2), 23.3 days (n = 9) and 29 days (n = 1) respectively. Number of deaths observed in ISS stage I, II and III were 0 (0/2), 2 (2/9) and 1 (1/1) respectively. Conclusions: Autologous stem cell transplant (ASCT) for AL amyloidosis is a feasible, effective and safe procedure outside of major national referral centers. Pretransplant stratification of amyloidosis patients using ISS for multiple myeloma indicated a trend towards longer peri-transplant hospital stay and mortality with increasing ISS stage. This hypothesis needs to be tested in larger studies. No significant financial relationships to disclose.

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Pretransplant hemoglobin and serum creatinine levels correlate with progression free survival in myeloma patients undergoing autologous stem cell transplantation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e19532 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e19532-e19532

Author(s):

Taner Demirer ◽

Guldane Cengiz Seval ◽

Selami Kocak Toprak ◽

Sinem Civriz Bozdag ◽

Meltem Kurt Yuksel ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Serum Creatinine ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Progression Free Survival ◽

High Dose ◽

Free Survival ◽

The Impact

e19532 Background: High dose melphalan and autologous stem cell transplantation (ASCT) significantly prolong survival for patients with multiple myeloma (MM). The purpose of this study is to assess the effects of hemoglobin (Hgb) and serum creatinine (Crea) values at the time of transplantation on the overall outcome of patients with multiple myeloma treated at our transplant center. Material & Methods: This analysis included 247 consecutive patients who underwent ASCT for MM between 2010-2016. Hemoglobin was grouped as low or high relative to their sample median. Patients were also stratified according to serum Crea value at the time of transplantation ( < 2 or ³2 mg/dl). Results: The median age was 57 (29-75) years and most patients were male (n = 151, 61.1%), IgG subtype (n = 124, 50.2%), and ISS stage 3 (n = 122, 49.4%). The interval from the time of diagnosis to ASCT was median 7 months and median follow-up from ASCT was 49 months (range, 3-198 months). The most commonly induction regimens included VAD (vincristine, doxorubicin and dexamethasone) and VCD (bortezomib, cyclophosphamide, dexamethasone), respectively. Since maintenance was not an approved treatment in myeloma most patients did not receive any. For the entire cohort, the median Hgb and Crea were 11.5 g/dL and 0.9 mg/dL respectively. No difference in progression free survival (PFS) was observed between a lower and higher Hgb (82 vs. 81 months, p = 0.96). However, the median PFS was significantly longer in patients with a lower Crea compared to those with a higher Crea (83 vs. 48 months, p = 0.01). Patients with both a lower hemoglobin and higher Crea experienced shorter PFS compared to those with a higher hemoglobin and lower Crea (45 vs. 82 months, p < 0.001). We failed to demonstrate the impact of creatinin levels on time to neutrophil and platelet engraftment. There were no differences in OS according to lower vs. higher Hgb (58 vs. 52 months; p = 0.29, respectively) but in higher crea cohort worse OS was observed (41 months vs. 57 months; p = 0.02, respectively). Conclusions: We demonstrate that hemoglobin and creatinine represent important determinants of clinical outcomes after ASCT. A lower hemoglobin and higher creatinine, individually and when combined, were associated with shorter PFS. Therefore, further studies of larger randomized cohorts are required to clarify the impact of pre-transplant Hgb and Crea levels on ASCT outcomes.

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The Survival of Multiple Myeloma Patients: A Single Institution Study.

Blood ◽

10.1182/blood.v104.11.5223.5223 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5223-5223

Author(s):

Zwi N. Berneman ◽

An-Sofie Verstraete ◽

Alain Gadisseur ◽

Ann Van de Velde ◽

Wilfried A. Schroyens

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Progression Free Survival ◽

High Dose Chemotherapy ◽

High Dose ◽

Conventional Chemotherapy ◽

Free Survival

Abstract Background: For a long time, multiple myeloma has been a disease with a poor outcome. High dose (melphalan) chemotherapy followed by autologous stem cell transplantation has been reported to improve the overall and progression-free survival of these patients. Objective: To determine the survival of multiple myeloma patients treated with conventional chemotherapy and compare it with that of patients treated with high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation. Design/Methods: 83 myeloma patients treated at a single institution were included in this retrospective study. They were divided into two groups: one group of patients who were received high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (n=42) and one group of patients who only received conventional chemotherapy and were eventually also treated with thalidomide and/or corticosteroids (n=41). The distribution of the stages of the disease according to Salmon and Durie were similar in both groups of patients. For both groups, the overall and progression-free survival was calculated. Results: In the general analysis, myeloma patients who underwent an autologous transplant had a significantly longer overall survival (58.8 vs. 52.2 months, p=0.036) and progression-free survival (39.6 vs. 11.8 months, p < 0.001) in comparison with the conventional chemotherapy group. If analysis was restricted to those patients who were transplanted as a first-line treatment, there was no significant difference in overall survival in comparison with conventional chemotherapy (51.8 vs. 52.2 months, p= 0.422); progression-free survival was significantly better in the first-line transplant arm as compared to the conventional chemotherapy arm (35.4 vs. 11.8 months, p= 0.003). As the median age in the transplant arm was significantly lower than in the conventional chemotherapy arm, we also performed a sub-analysis of patients who were between 60 and 70 years of age at diagnosis; there was no significant difference in overall survival between the two groups (60.7 vs. 69.5 months, p= 0.656), while the progression-free survival was again better in the autologous transplant group as compared to the conventional chemotherapy group (41.0 vs. 8.4 months, p= 0.020). Conclusion: High-dose chemotherapy and autologous stem cell transplantation in the treatment of myeloma is associated with improved progression-free survival and in the general analysis, with improved overall survival. The overall survival of patients who were only treated with conventional chemotherapy is somewhat higher (more than 4 years) as compared to that of historical controls (2–3 years).

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Bortezomib Given in Sequence with Anthracycline and Thalidomide-Containing Regimens Does Not Adversely Affect Stem Cell Mobilization and Engraftment in Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation.

Blood ◽

10.1182/blood.v104.11.541.541 ◽

2004 ◽

Vol 104 (11) ◽

pp. 541-541

Author(s):

Geoffrey L. Uy ◽

Nicholas M. Fisher ◽

Steven M. Devine ◽

Hanna J. Khoury ◽

Douglas R. Adkins ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Hematopoietic Stem Cell ◽

Peripheral Blood ◽

Stem Cell Mobilization ◽

High Dose ◽

Hematopoietic Stem ◽

Cd34 Cells ◽

Cell Mobilization ◽

High Dose Melphalan

Abstract Bortezomib (VELCADE®) is a selective inhibitor of the 26S proteasome proven to be safe and effective in the treatment of relapsed or refractory multiple myeloma (MM). While high-dose chemotherapy with autologous hematopoietic stem cell transplant (AHSCT) remains the standard of care, there is considerable interest in incorporating bortezomib into the initial treatment of MM. However, the role of bortezomib in frontline therapy for MM will depend in part on its effects on subsequent stem cell mobilization and engraftment. We conducted a pilot study of bortezomib administered pretransplant followed by high-dose melphalan with AHSCT. Two cycles of bortezomib 1.3 mg/m2 were administered on days 1, 4, 8, and 11 of a 21-day treatment cycle. One week after the last dose of bortezomib, stem cell mobilization was initiated by administering filgrastim 10 mcg/kg/day subcutaneously on consecutive days until stem cell harvest was completed. Stem cell collection began on day 5 of filgrastim via large volume apheresis (20 L/day) performed daily until a minimum of 2.5 x 106 CD34+ cells/kg were collected. Patients were subsequently admitted to the hospital for high-dose melphalan 100 mg/m2/day x 2 days followed by reinfusion of peripheral blood stem cells 48 hours later. Sargramostim 250 mcg/m2/day subcutaneously was administered starting day +1 post-transplant and continued until the absolute neutrophil count (ANC) ≥ 1,500/mm3 for 2 consecutive days. To date, 23 of a planned 40 patients have been enrolled in this study with 19 patients having completed their initial therapy with bortezomib followed by AHSCT. Patient population consists of 16 male and 7 female patients with the median age at diagnosis of 58 years (range 38–68). Myeloma characteristics at diagnosis were as follows (number of patients): IgG (16), IgA (7) with stage II (9) or stage III (14) disease. Prior to receiving bortezomib, 11 patients were treated with VAD (vincristine, Adriamycin and dexamethasone) or DVd (Doxil, vincristine and dexamethasone), 5 patients with thalidomide and 5 patients with both. Two patients did not receive any prior chemotherapy. All patients successfully achieved the target of 2.5 x 106 CD34+ cells/kg in either one (15/19 patients) or two (4/19 patients) collections with the first apheresis product containing a mean of 5.79 x 106 CD34+ cells/kg. Analysis of peripheral blood by flow cytometry demonstrated no significant differences in lymphocyte subsets before and after treatment with bortezomib. Following AHSCT, all patients successfully engrafted with a median time to neutrophil engraftment (ANC ≥ 500/mm3) of 11 days (range 9–14 days). Platelet engraftment (time to platelet count ≥ 20,000/mm3 sustained for 7 days without transfusion) occurred at a median of 12 days (range 9–30 days). Eleven patients were evaluable for response at 100 days post-transplant. Compared to pre-bortezomib paraprotein levels, 3 patients achieved a CR or near CR, 7 maintained a PR while 1 patient developed PD. We conclude that pretransplant treatment with 2 cycles of bortezomib does not adversely affect stem cell yield or time to engraftment in patients with MM undergoing AHSCT. Updated results and detailed analysis will be available at the time of presentation.

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Stem Cell Mobilization after Various Induction Regimens in Patients with Multiple Myeloma

Blood ◽

10.1182/blood.v126.23.5433.5433 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5433-5433

Author(s):

Jakub Radocha ◽

Vladimir Maisnar ◽

Miriam Lanska ◽

Jiri Hanousek ◽

Katerina Machalkova ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Conflicts Of Interest ◽

Rapid Development ◽

Autologous Transplantation ◽

Stem Cell Mobilization ◽

High Dose ◽

Cell Transplant ◽

Cell Mobilization ◽

Stem Cell Collection

Abstract Stem cell mobilization after various induction regimens in patients with multiple myeloma Introduction: Rapid development of novel therapies for multiple myeloma has led to a significant improvement in response to the treatment. Stem cell mobilization before autologous stem cell transplantation is a source of considerable costs of transplant procedure. Whether modern induction regimens affect outcome of stem cell mobilization has not been extensively studied. Aim: The goal of this study was to compare efficacy of stem cell mobilization after different induction regimens in patients with multiple myeloma. The primary goal was to compare CTD (cyclophosphamide, thalidomide, dexamethasone), CVD (cyclophosphamide, bortezomib, dexamethasone) and VTD (bortezomib, thalidomide, dexamethasone) and regimens in terms of succesful stem cell collection. Methods: All patients with multiple myeloma who have been planned for stem cell collection and were treated with one of the above mentioned regimens were included in this retrospective analysis. The demographic data, amount of stem cells collected, number of days needed to reach the target collection were recorded. All patients received high dose cyclophosphamide 2,5 g/m2 prior to stem cell collection and were primed with G-CSF twice daily from day 5. The collection was started at day 10. Collection goal was 8x106/kg CD34+ cells. Results: 15 patients received CTD, 25 patients CVD and 16 patients VTD regimen before stem cell collection. Groups were comparable according to age, gender and myeloma stages. Mean collected cells at the end of collection were 9.2 (SD 2.8) for CTD, 12.3 (SD 5.6) for CVD and 10.1 (SD 2.1) for VTD (p=0.066). Mean daily harvest was 3.4, 8.0 and 7.6 x106/kg respectively (p=0.01). Mean days needed to reach desired harvest were 3, 2.25 and 1.6 days (p=0.001). No collection failure was observed. Conclusion: The best collection results were seen in patients after induction with CVD or VTD regimen. VTD regimen also required the least days for collection and seems to be most beneficial for cost of collection. CTD regimen shows the least efficacy in stem cell collection before autologous transplantation. All patients managed to harvest for at least one stem cell transplant. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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