Disparities in utilization of autologous stem cell transplantation as consolidative therapy for multiple myeloma: A single-institution retrospective review.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20504-e20504
Author(s):  
Oleksandra Lupak ◽  
Xiaoxia Han ◽  
Neha Patil ◽  
Kannan Thanikachalam ◽  
Peter Xie ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
African American ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Survival Time ◽  
Cell Transplantation ◽  
Retrospective Review ◽  
Transplant Outcomes ◽  
Related Mortality

e20504 Background: Multiple Myeloma (MM) accounts for about 17% of hematologic malignancies in the United States. It is a disease of older adults, with a median age at diagnosis of 66 years. The incidence in African Americans is 2 to 3 times more that in Whites, and this disparity has been found to be greater among patients less than 50 years. Most guidelines recommend induction therapy with a triplet regimen followed by autologous hematopoietic cell transplantation (HCT). Unfortunately, racial and ethnic minorities have been found to be less likely to receive ASCT. A SEER-Medicare database analysis from 2000 to 2011 noted a lower utilization of ASCT and Bortezomib among black patients. The goal of this study was to evaluate patterns of acceptance of ASCT as consolidative therapy of MM. Because the receipt of upfront ASCT is dependent on response to induction therapy, our study also investigated disparity in transplant outcomes and time to transplant, which are areas that previous studies had not looked at. Methods: In this retrospective review we used Cox PH model to investigate the association between the survival time of the patients (OS) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. 194 patients with a confirmed diagnosis of MM who were referred for autologous hematopoietic stem cell transplantation (ASCT) between January 1st 2009 and June 30st 2019 were included in this study. Patients who received ASCT for relapsed MM were excluded. Results: Using Cox PH model, we found that high risk cytogenetic were significantly associated with shorter overall survival, higher transplant related mortality and relapse related mortality (P < 0.002). Use of aggressive induction choices was associated with poorer transplant outcomes (P 0.02). Time to transplant tended to be shorter in African American compared to other ethnic groups (P 0.07). Income category was not significantly associated with overall survival, time to transplant or transplant / relapse related mortality. Conclusions: Cytogenetic continues to be a significant factor in transplant outcomes affecting overall survival. Time to transplant tended to be shorter in African American comparing to others, potentially reflecting the differences in disease course. Our study provides a more real life data on ASCT outcome patterns. It is hoped that the results of this study will better guide interventions to improve utilization of ASCT as consolidative therapy for MM.

Prolongation of Post Relapse and Overall Survival in Patients with Multiple Myeloma by Salvage Strategy with the Combination of Thalidomide and Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation Based on the Nature of Disease Progression after Autologous Bone Marrow Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3494-3494
Author(s):  
Izhar Hardan ◽  
Avichai Shimoni ◽  
Abraham Kneller ◽  
Abraham Avigdor ◽  
Noga Shemtov ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Reduced Intensity Conditioning ◽  
Duration Of Response ◽  
Reduced Intensity ◽  
Related Mortality

Abstract The impact of the use of autologous BMT (ABMT) as an up-front therapy on the natural history of multiple myeloma (MM) is limited, mainly due to the course of disease at progression after ABMT. Conventional salvage at that stage was reported to offer overall survival of only 14–17 months. The benefit of thalidomide and reduced intensity allogeneic stem cell transplantation (RIC SCT), which were introduced at that stage, is limited by the duration of response and toxicity. It was shown, however, that the aggressiveness of relapse clearly predicts for outcome in this set-up. Methods. Patients (pt’s) with progression after ABMT were treated according to a strategy based on the nature of relapse, with thalidomide (Thal) and reduced intensity conditioning allogeneic stem cell transplantation (RIC SCT) as following: all progressing patients had Thal ± Dexa for induction of response, but only at a clinical indication for therapy. DTPACE combination was given to those who failed to respond to Thal. Pt’s with aggressive progression were offered a RIC SCT at response, while patients with an indolent progression were offered a RIC SCT only at escape from response to Thal or if being resistant to Thal+Dexa. Re-induction therapy was delivered prior to transplant. The post transplant therapy included DLI and/or Thal according to the findings in minimal residual disease (MRD) studies and base line chromosomal studies. Results. Seventy five pts (age 36–66, median 58 y) with indolent (n= 46, 61%) or aggressive (n=29, 39%) progression, were treated according to this strategy. The overall response rate (= or &gt;PR) to Thal ± Dexa was 58.6%. Thirty six pt’s (48%) subsequently underwent RIC SCT (27 related, 9 unrelated donor) and 10 pts with an indication but no matched donor had a 2nd ABMT. Treatment related mortality was 9.3% (7 pt, all after RIC SCT, giving transplant related mortality rate of 16.6% for RIC SCT in this setting). RIC SCT reversed resistant to Thal in 7 pt. The median overall survival (OS) from progression of the entire group is 39 months with a projected 3-years survival rate of 52% (follow-up 19m-74m, median= 34m). The nature of relapse was found to be a strong independent favorable prognostic factor with a median post relapse OS of &gt;62m (not yet reached) vers. 24m, for pt’s with indolent compared with aggressive relapse (p=0.00002). In 24 patients (32%), the duration of response exceeded the first progression free period (from ABMT until progression). The median OS from ABMT of this group of patients is 85m, compared with a median OS rate of 56m from ABMT in a comparable historical group of 62 patients from our center that relapsed after ABMT prior to the introduction of the Thal /RIC SCT strategy. Conclusion. The therapy with Thal and RIC SCT with a strategy based on the nature of disease progression after ABMT can improve post relapse and overall survival of MM patients. This may significantly add to the contribution of ABMT to the outcome of therapy in MM.

The Use of Combination PACE Regimens for Patients with Relapsed and Refractory Multiple Myeloma (MM) and Their Impact on Stem Cell Transplantation (SCT)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5127-5127
Author(s):  
Marcin Puto ◽  
Nelly G. Adel ◽  
Hani Hassoun ◽  
Sergio Giralt ◽  
Heather Landau
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Partial Response ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Median Overall Survival ◽  
Combination Regimen ◽  
Number Of Patients ◽  
Related Mortality

Abstract Abstract 5127 Introduction: The treatment of newly diagnosed multiple myeloma (MM) has dramatically improved with the introduction of immune modulating agents and proteasome inhibitors. However, the management of patients with relapsed or refractory disease remains challenging. For these patients, one approach is the use of the chemotherapy combination PACE (cisplatin, adriamycin, cyclophosphamide, and etoposide) in conjunction with thalidomide, lenalidomide or often bortezomib. At Memorial Sloan-Kettering Cancer Center (MSKCC), these PACE-based regimens are utilized as salvage option, prior to first autologous stem cell transplantation (ASCT) for patients with disease refractory to usual induction therapy or as salvage regimen in patients with relapsed, often heavily pre-treated MM in an attempt to proceed to salvage SCT. The objective of this study is to describe the experience in using PACE regimens in relapsed and refractory patients with MM at MSKCC and their impact on SCT. Methods: We preformed a retrospective chart review of all patients with MM who were treated with a combination regimen of VDT (bortezomib, dexamethasone and thalidomide)-PACE, DT (dexamethasone and thalidomide)-PACE, or DR (dexamethasone and lenalidomide)-PACE between 1/2007 and 6/2010 at MSKCC. After obtaining IRB-waiver, patient demographics, baseline disease characteristics, treatment and transplant history were collected using the hospital's pharmacy database and electronic medical records. Responses were graded according to the International uniform myeloma response criteria. The number of patients that were able to undergo stem cell collection and/or transplant, as well as transplant-related mortality and overall survival were also determined. Results: A total of 32 refractory/relapsed patients with MM who received either VDT-PACE, DT-PACE, or DR-PACE regimen were included in the study. Ten patients received the treatment as a bridge to first ASCT (upfront cohort) and 22 as salvage prior to second or third ASCT or allogenic SCT (salvage cohort). Half of the patients in the upfront cohort received VDT-PACE (N=5), and the remainder received either DT-PACE (N=4) or DR-PACE (N=1). The majority of patients in the salvage cohort received DT-PACE (N=19), but others received VDT-PACE (N=2) and DR-PACE (N=1). Of the 10 patients in the upfront cohort, 20% achieved a partial response (PR), 40% stable disease (SD), 10% had progression of disease (PD) and 30% could not be assessed. Eighty percent of patients were successfully mobilized (defined as CD34+ > 2 × 106cells/kg) and 50% (N=5) proceeded to ASCT. The remaining 50% did not undergo autologous SCT, due to disease progression (N=3), treatment-related debility (N=1) and (N=1) was lost to follow up. In the salvage cohort, 18% achieved a complete response CR, 9% very good partial response VGPR, 23% PR, 14% SD and 36% PD following treatment with PACE combinations. Fifty-five percent of patients proceeded to SCT, including 6 patients who received salvage autologous SCT and 6 allogenic SCT. Transplant related mortality in both cohorts was 6% (1/17) with a single death occurring in a relapsed patient (salvage cohort) who underwent allogenic SCT. The median overall survival in the upfront cohort was significantly longer for patients who proceeded to SCT compared to those who did not, 12 versus 3.5 months. The median overall survival of patients in the salvage cohort who received SCT was 9.3 compared to 5.8 months in those who were not able to undergo SCT. Conclusion: At MSKCC PACE regimens controlled disease in patients with relapsed/refractory MM with responses seen in patients who were heavily pretreated including those with prior transplantation. This treatment allowed over half of the patients to proceed to SCT and those who underwent autologous or allogeneic SCT after PACE regimens had a longer survival. However, outcomes for relapsed and refractory patients with MM remain poor and other strategies such as maintenance or immunotherapy following first or subsequent transplant should be studied in order to extend the survival of these patients. Disclosures: Giralt: CELGENE: Consultancy, Honoraria, Speakers Bureau; MILLENIUM: Consultancy, Honoraria, Speakers Bureau; NOVARTIS: Consultancy, Honoraria; GENZYME: Consultancy, Honoraria, Speakers Bureau; AMGEN: Consultancy, Honoraria; ONYX: Consultancy, Honoraria.

Plasmablastic Morphology Is an Independent Predictor of Poor Survival After Autologous Stem-Cell Transplantation for Multiple Myeloma

1999 ◽  
Vol 17 (5) ◽  
pp. 1551-1551 ◽  
Author(s):  
S. Vincent Rajkumar ◽  
Rafael Fonseca ◽  
Martha Q. Lacy ◽  
Thomas E. Witzig ◽  
Terry M. Therneau ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Survival Time ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Independent Predictor ◽  
Progression Free Survival ◽  
Poor Survival ◽  
Free Survival

PURPOSE: To study the prognostic value of plasmablastic morphology after autologous stem-cell transplantation for relapsed or primary refractory myeloma. PATIENTS AND METHODS: Seventy-five patients were studied. Investigators blinded to the clinical details of the individual cases reviewed bone marrow aspirate slides to determine plasmablastic classification. Plasmablasts were defined using strict, well-described criteria. Plasmablastic morphology was considered to be present (plasmablastic myeloma) when 2% or more plasmablasts were present in the plasma-cell population. RESULTS: Patients underwent transplantation 5 to 88 months (median, 20 months) after the initial diagnosis of myeloma. Twenty-eight percent of patients had plasmablastic morphology. A significantly greater proportion of patients with plasmablastic morphology had abnormal cytogenetics compared with those with nonplasmablastic classification (73% v 31%, respectively; P = .003). The overall survival rate measured from the time of transplantation was significantly worse in patients with plasmablastic morphology compared with those without (median survival time, 5 months v 24 months, respectively; P < .001). Progression-free survival time was shortened also, with a median time of 4 months compared with 12 months, respectively (P < .001). In the multivariate analysis, plasmablastic classification was the most powerful prognostic factor after transplantation for both overall (P = .001) and progression-free survival rates (P < .001). We also identified three risk groups based on plasmablastic morphology: plasma-cell labeling index, lactate dehydrogenase, and cytogenetics. The median overall survival time was 38 months when none of these factors was abnormal, 17 months with one abnormal factor, and 8 months with two or more abnormal factors (P < .001). CONCLUSION: Plasmablastic morphology is a powerful independent predictor of poor survival rate after autologous stem-cell transplantation for relapsed or primary refractory myeloma.

scholarly journals Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma

2019 ◽  
Vol 37 (19) ◽  
pp. 1617-1628 ◽  
Author(s):  
Sam H. Ahmedzai ◽  
John A. Snowden ◽  
Andrew John Ashcroft ◽  
David Allan Cairns ◽  
Cathy Williams ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Adverse Effects ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Random Assignment ◽  
Time To Progression ◽  
Patient Reported

PURPOSE Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT. METHODS Patients were randomly assigned to either sASCT or nontransplantation consolidation (NTC). Pain and QoL were assessed as secondary outcomes using validated QoL instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and myeloma-specific module, QLQ-MY20; the Brief Pain Inventory [Short Form]; and the Leeds Assessment of Neuropathic Symptoms and Signs [Self-Assessment] scale). RESULTS A total of 288 patients (> 96%) consented to the QoL substudy. The median follow-up was 52 months. The European Organisation for Research and Treatment of Cancer QLQ-C30 Global health status scores were higher (better) in the NTC group at 100 days after random assignment ( P = .0496), but not at later time points. Pain interference was higher (worse) in the sASCT group than in the NTC group at 6 months after random assignment ( P = .0267), with patients with sASCT reporting higher scores for Pain interference with daily living for up to 2 years after random assignment. Patients reporting lower concerns about adverse effects of treatment after sASCT had a time to progression advantage. CONCLUSION Patients with sASCT with relapsed MM demonstrated a comparative reduction in QoL and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received sASCT reported better outcomes. Patients who experienced lower adverse effects after sASCT had longer time to progression and overall survival, showing the need to improve symptom management peritransplantation. To our knowledge, this study provides the most comprehensive picture of QoL before and after sASCT in patients with relapsed MM.

Third Autologous Stem Cell Transplantation for Relapsed Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4548-4548
Author(s):  
Catherine Garnett ◽  
Chrissy Giles ◽  
Maialen Lasa ◽  
Osman Ahmed ◽  
Marco Bua ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Disease Progression ◽  
Cell Transplantation ◽  
Median Time ◽  
Autologous Stem Cell Transplantation ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant

Abstract Abstract 4548 High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is currently standard treatment for younger patients with multiple myeloma (MM). In the face of almost inevitable disease relapse, there is growing evidence for second ASCT as salvage therapy in certain patient groups. However, few published data exist regarding efficacy and safety of third ASCT in relapsed disease. We retrospectively analysed the results of eight patients treated at a single UK institution who each received three separate autologous stem cell transplants for relapsed MM between May 1997 and April 2012. There were four men and four women. Median age at diagnosis was 48 years (range, 25–64 years). Paraprotein isotype was IgA in two patients and IgG in the remaining six patients. At the time of 1st transplant, seven patients were in partial response (PR) and one in complete response (CR). Conditioning melphalan dose was 200mg/m2 in all but two patients who received 140mg/m2. Three patients entered CR following 1st transplant and four patients showed PR. Median time to disease progression was 31 months (range, 11.8–52.9 months). Prior to 2nd transplant, five patients achieved very good partial response (VGPR) and three PR with induction chemotherapy. Melphalan dose was 200mg/m2 in five patients and 140mg/m2 in the remaining three. Median time to disease progression was 22.3 months (range, 10.1– 39.6 months). At the time of 3rd transplant, two patients had achieved VGPR following induction chemotherapy, one showed PR, two stable disease (SD) and three evidence of disease progression. For the 3rd transplant, melphalan dose was reduced in most cases. Median follow up post 3rd transplant was 8.3 months (range 1.1–29.3 months). One patient died of overwhelming sepsis within one month of transplantation (treatment related mortality). At the time of analysis, five patients had relapsed following 3rd ASCT, with median time to disease progression of 10.4 months (range, 2.7–23.7 months). Three of these patients died at 3.5, 17.6 and 27.1 months post 3rd transplant. The remaining two patients are alive with no evidence of disease relapse (progression free survival (PFS) time of 3.3 and 1.3 months). Overall survival (OS) for the group from diagnosis is 62% at 10 years with a median OS from diagnosis of 149 months (range 68.5 – 189.2 months) (Figure 1). Median OS for the group from 3rd transplant is 17.6 months (range, 1.1–29.3 months) (Figure 2). Median PFS is 10.4 months (range 1.1–23.7 months). These results demonstrate that third ASCT is a possible treatment strategy for patients with relapsed MM and may prolong patient survival. Figure 1: Overall survival from diagnosis for patients receiving 3rd autologous stem cell transplantation for relapsed multiple myeloma Figure 1:. Overall survival from diagnosis for patients receiving 3rd autologous stem cell transplantation for relapsed multiple myeloma Figure 2: Overall survival from time of 3rd autologous stem cell transplant Figure 2:. Overall survival from time of 3rd autologous stem cell transplant Disclosures: No relevant conflicts of interest to declare.

NON-Cryopreserved Hematopoietic STEM CELL Transplantation in Multiple Myeloma. a Single Center Experience in Oran (ALGERIA)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1990-1990
Author(s):  
Amine MA Bekadja ◽  
Souad ST Talhi ◽  
Hafida OH Ouldjeriouat ◽  
Osmani OS Soufi ◽  
Mohamed BM Brahimi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Hematopoietic Stem

Abstract Introduction: For younger patients under 65 years of age, induction followed by high-dose chemotherapy with autologous stem cell transplantation (ASCT) is the standard treatment in multiple myeloma (MM). There is limited experience with non-cryopreserved autologous hematopoietic stem cell transplantation. We evaluated the efficacy and safety of non-cryopreserved storage of ASCT in patients undergoing ASCT for MM. Patients and methods: Autologous stem cell was mobilized using G-CSF alone (10 µg/kg/day for 5 days). Leukapheresis to harvest stem cells were performed on day -2 and -1. The grafts were kept in a conventional blood bank refrigerator at +4°C until reinfusion on day 0. The conditioning regimen consisted of melphalan 200 mg/m2 in all patients. Results: From May 2009 to December 2013, 134 patients with MM were treated in our center in Oran. The median age at ASCT was 55 years (range; 27-67). There were 80 males and 54 females. The median harvested CD34+ cell count was 3,5x106/kg (range; 1, 22 to 13, 24). All patients had engraftment on the median of day 10 (range; 7 to 17) and platelet transfusion independence on the median of day 13 (range; 9 to 24). There was no graft failure. Mucositis grade 3/4 was seen in 68% patients. Transplant related mortality at 100 days was 2.9%. The overall response to transplant was 92%. In the 130 evaluable patients, the median post-transplant overall survival had not been reached. The estimated overall survival at 75 months was 63% with 95% confidence interval and the median post-transplant disease free Survival was 35 months (0.05%). 93 (72%) patients are alive and 75 (81%) without disease activity after a median follow-up of 35 months (range; 3 to 75). Discussion: We conclude that high dose chemotherapy and autologous transplant with non cryopreserved ASCT is a simple, effective and safe method for MM with equivalent results, and that cryopreservation is not necessary in the treatment of MM under our work conditions in developing countries Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of Different Mobilization Methods on Graft Composition and Outcome after Autologous Stem Cell Transplantation: Implications for Upfront Use of Plerixafor

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1125-1125
Author(s):  
LaQuisa Hill ◽  
Oluchi C. Ukaegbu ◽  
Bipin N. Savani ◽  
Salyka Sengsayadeth ◽  
Stacey Goodman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Partial Remission ◽  
Progression Free Survival ◽  
Free Survival ◽  
Disease Response ◽  
Graft Composition

Abstract Early lymphocyte recovery (ELC) is associated with improved outcomes of hematologic malignancies after autologous hematopoietic stem cell transplantation (auto-SCT). ELC, its composition and impact on outcome depends on many variables; however there is limited data on ELC after different mobilization strategies (G-CSF [G] vs. G + high dose cyclophosphamide [GC] vs. G + plerixafor [GP]). Results from a recent study showed that GP based mobilization can affect the number and subsets of immune competent cells contained in the graft. We studied whether these differences are associated with immune reconstitution (ELC), engraftment, or long-term outcomes. We retrospectively identified patients undergoing auto-SCT at the Nashville VA Transplant Center between January 2000 and December 2010 in our CIBMTR database. Disease response was determined by standard CIBMTR response criteria. At our center, GP mobilization is reserved for patients who failed prior mobilization, to rescue G or GC mobilization, or as upfront usage in heavily pre-treated patients. Our patient cohort primarily included patients with multiple myeloma (MM) and lymphoma (LY). We had evaluable data on 333 patients (MM=196; LY=127; others=10). Comparative analysis of different mobilization methods are summarized in Table 1. Median number of regimens pre-SCT for MM was 2 (range 1-5) and for lymphoma 2 (range1-7). Among LY patients, 60 (47.3%) patients were in complete remission (CR), 58 (45.7%) in partial remission (PR) and 9 (7%) had stable disease (SD). Among MM patients, 69 (35.2%) were in CR or very good partial remission (VGPR) pre-transplant, 105 (53.5%) were in PR, and 14 (7.1%) had SD. There was no significant difference between disease response status among different mobilization methods for either the MM or LY patients. A higher absolute WBC count was seen in grafts after GP mobilization compared to G or GC (p=0.01), despite a majority of patients having received GP mobilization after failed G or GC mobilization, or as a rescue regimen (n=20 [89%]). Similarly, absolute lymphocyte counts were higher in grafts mobilized after GP compared to G or GC (p=0.01). All patients engrafted and there was no difference in time to WBC or platelet engraftment between mobilization methods. Although the GP cohort was more heavily treated than the other cohorts (>2 regimens for GP 82%, vs. G 72% vs. GC 58% [p=0.02]), progression-free survival (PFS) and overall survival (OS) of G vs. GC vs. GP at 2-years was not significantly different between MM and LY cohorts (Table 1). In summary, grafts mobilized with GP exhibited major differences in graft composition in conjunction with favorable post- transplant outcomes compared with grafts mobilized with G or GC. GP mobilization accelerated lymphocyte engraftment in this heavily treated group compared to G or GC. For patients proceeding to transplant heavily pre-treated, GP is a better mobilization method to ensure a robust graft is collected while avoiding the need for multiple stem cell collections and providing similar outcomes as patients less heavily treated and mobilized by G or GC. A prospective randomized controlled trial would elucidate whether progression free survival and overall survival might be improved by utilizing GP mobilization as a first-line therapy rather than as a rescue method. Table 1. Graft composition and outcomes of different stem cell mobilization methods Variable G (n=97) GC (n=213) GP (n=23) P value Numbers of regimens pre-SCT, median 2.2 (95% CI, 2.0-2.4) 1.9 (1.8-2.0) 2.3 (1.9-2.7) 0.02 WBC in graft, median (range) 184.8 (12-777.7) 138.6 (11-542) 286.1 (186-400.3) 0.01 Absolute lymphocyte in graft (x103), median (range) 128.1 (13-321.1) 73.9 (3.4-433.6) 161.2 (47.4-302.0) 0.01 ANC >500 (days), median (range) 16 (11-25) 15 (7-86) 18 (13-24) 0.16 Platelets >20 (days), median (range) 13 (9-22) 12 (7-18) 12 (10-21) 0.07 OS (2 year) Lymphoma 74.5 77.9 72.7 0.054 Multiple myeloma 89.6 74.4 72 0.76 PFS (2 year) Lymphoma 58.2 57.6 46.1 0.1 Multiple myeloma 66.3 49 60 0.21 Disclosures No relevant conflicts of interest to declare.

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