Higher efficacy of Etoposide + Cytarabine Plus Pegfilgrastim in poorly mobilizing Multiple Myeloma and lymphoma Patients

by Selleckchem | Jul 13 2023

Background aims: An optimal strategy for mobilizing hematopoietic stem cells in poorly mobilizing patients with multiple myeloma (MM) and lymphoma has not yet been determined.

Methods: We retrospectively analyzed the efficacy and safety of etoposide combined with cytarabine (etoposide 75 mg/m2, daily d1∼2; Ara-C 300 mg/m2, every 12 h d1∼2), plus pegfilgrastim (6 mg d6) in 32 patients with MM or lymphoma, among whom 53.1% were defined as "proven poor mobilizers."

Results: This approach resulted in adequate mobilization (≥2.0 × 106 CD34+ cells/kg) in 93.8% of patients and optimal mobilization (≥5.0 × 106 CD34+ cells/kg) in 71.9% of patients. A total of 100% of patients with MM reached at least 5 × 106 CD34+ cells/kg collected, the amount required for double autologous stem cell transplant. In total, 88.2% of patients with lymphoma reached at least 2 × 106 CD34+ cells/kg collected, the amount required for a single autologous stem cell transplant. This was achieved with a single leukapheresis in 78.1% of cases. A median peak number of 42.0/μL circulating CD34+ cells and a median number of blood CD34+ cells counts in 6.7 × 106/L were collected among 30 successful mobilizers. Approximately 6.3% of patients required plerixafor rescue, which was successful. Nine (28.1%) of the 32 patients suffered grade 2∼3 infections, and 50% required platelet transfusions.

Conclusions: We conclude that chemo-mobilization with etoposide, Ara-C and pegfilgrastim in poorly mobilizing patients with MM or lymphoma is very effective and has acceptable toxicity.

Comments:

The retrospective analysis evaluated the efficacy and safety of a mobilization strategy for hematopoietic stem cells in patients with multiple myeloma (MM) and lymphoma who were considered poor mobilizers. The strategy involved the combination of etoposide and cytarabine, along with pegfilgrastim, a medication that stimulates the production of white blood cells.

The results of the analysis showed promising outcomes. Among the 32 patients included in the study, 93.8% achieved adequate mobilization (≥2.0 × 106 CD34+ cells/kg) and 71.9% achieved optimal mobilization (≥5.0 × 106 CD34+ cells/kg). Importantly, all patients with MM reached the target of at least 5 × 106 CD34+ cells/kg, which is the required amount for double autologous stem cell transplantation. In patients with lymphoma, 88.2% reached the minimum requirement of 2 × 106 CD34+ cells/kg for a single autologous stem cell transplant. Moreover, in the majority of cases (78.1%), a single leukapheresis procedure was sufficient for successful collection of the required stem cells.

The analysis also reported the median peak number of circulating CD34+ cells to be 42.0/μL, and the median number of blood CD34+ cell counts collected was 6.7 × 106/L among the 30 patients who successfully underwent mobilization. In a small percentage of patients (6.3%), additional treatment with plerixafor, a medication that enhances stem cell mobilization, was required, and this rescue treatment was successful.

In terms of safety, 28.1% of patients experienced grade 2 to 3 infections, indicating a moderate level of infectious complications. Additionally, 50% of patients required platelet transfusions, suggesting a need for supportive care measures during the mobilization process.

Based on these findings, the study concludes that the chemo-mobilization approach using etoposide, cytarabine, and pegfilgrastim is highly effective in poorly mobilizing patients with MM or lymphoma. The strategy demonstrates acceptable toxicity, considering the rates of infections and the need for platelet transfusions observed in the patient cohort. These results highlight the potential of this mobilization strategy as a viable option for patients who struggle with stem cell mobilization in the context of autologous transplantation.