Joanna Drozd-Sokołowska1, Anna Waszczuk-Gajda1, Magdalena Topczewska2, Joanna Mańko3,4, Iwona Hus3,4, Anna Szmigielska-Kapłon5, Mateusz Nowicki6, Iwona Grygoruk-Wiśniowska7, Małgorzata Krawczyk-Kuliś7,8, Joanna Romejko-Jarosińska9, Ewa Frączak10, Tomasz Wróbel10, Beata Piątkowska-Jakubas11, Krzysztof Mądry1, Piotr Boguradzki1, Małgorzata Król1, Magdalena Kozioł3, Marek Hus3, Anna Kopińska7, Anna Dmoszyńska3, Grzegorz Władysław Basak1, Jadwiga Dwilewicz-Trojaczek1. 1. Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. 2. Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland. 3. Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland. 4. Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland. 5. Department of Hematology, Medical University of Lodz, Lodz, Poland. 6. Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland. 7. Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland. 8. Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute-Cancer Center, Gliwice, Poland. 9. Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland. 10. Department of Hematology, Wroclaw Medical University, Wroclaw, Poland. 11. Department of Hematology, Jagiellonian University, Cracow, Poland.
Abstract
BACKGROUND: Salvage autologous hematopoietic stem cell transplantation (autoHSCT) may be used to treat relapse of multiple myeloma occurring after previous autoHSCT. When insufficient number of hematopoietic stem cells was stored from the initial harvest, remobilization of stem cells is necessary. PURPOSE: The analysis of stem cell remobilization after previous autoHSCT. PATIENTS AND METHODS: Fifty-eight patients, 60% males, median 59 years, were included. Median time interval between autoHSCT and remobilization was 42 months. The first remobilization was performed mostly after chemotherapy: cyclophosphamide (33%), cytarabine (43%), and etoposide (19%). RESULTS: The first remobilization was successful in 67% patients. About 19% patients required plerixafor rescue, among whom it allowed for successful harvesting in 14%. Use of cyclophosphamide, cytarabine, and etoposide allowed for successful remobilization in 53%, 84%, and 55% patients, respectively. Patients treated with cytarabine had the highest yield of CD34+ cells (median 7.5 × 106 /kg vs 5.8 and 2.4 for etoposide and cyclophosphamide, P = .001). Higher percentage of patients was able to collect ≥2 × 106 CD34+ cells/kg during one leukapheresis after cytarabine (76% vs 21% for cyclophosphamide vs 36% for etoposide, P = .001). Cytarabine use was associated with lower risk of remobilization failure OR = 0.217, P = .02. Toxicity comprised mostly hematological toxicity (thrombocytopenia and neutropenia). One patient succumbed to septic shock. CONCLUSION: Remobilization after previous autoHSCT is feasible only in a proportion of patients. Cytarabine is associated with the highest rate of successful mobilization and the highest yield of mobilized CD34+ cells. The toxicity requires careful surveillance of these patients.
BACKGROUND: Salvage autologous hematopoietic stem cell transplantation (autoHSCT) may be used to treat relapse of multiple myeloma occurring after previous autoHSCT. When insufficient number of hematopoietic stem cells was stored from the initial harvest, remobilization of stem cells is necessary. PURPOSE: The analysis of stem cell remobilization after previous autoHSCT. PATIENTS AND METHODS: Fifty-eight patients, 60% males, median 59 years, were included. Median time interval between autoHSCT and remobilization was 42 months. The first remobilization was performed mostly after chemotherapy: cyclophosphamide (33%), cytarabine (43%), and etoposide (19%). RESULTS: The first remobilization was successful in 67% patients. About 19% patients required plerixafor rescue, among whom it allowed for successful harvesting in 14%. Use of cyclophosphamide, cytarabine, and etoposide allowed for successful remobilization in 53%, 84%, and 55% patients, respectively. Patients treated with cytarabine had the highest yield of CD34+ cells (median 7.5 × 106 /kg vs 5.8 and 2.4 for etoposide and cyclophosphamide, P = .001). Higher percentage of patients was able to collect ≥2 × 106 CD34+ cells/kg during one leukapheresis after cytarabine (76% vs 21% for cyclophosphamide vs 36% for etoposide, P = .001). Cytarabine use was associated with lower risk of remobilization failure OR = 0.217, P = .02. Toxicity comprised mostly hematological toxicity (thrombocytopenia and neutropenia). One patient succumbed to septic shock. CONCLUSION: Remobilization after previous autoHSCT is feasible only in a proportion of patients. Cytarabine is associated with the highest rate of successful mobilization and the highest yield of mobilized CD34+ cells. The toxicity requires careful surveillance of these patients.
Authors: Joanna Drozd-Sokołowska; Luuk Gras; Nienke Zinger; John A Snowden; Mutlu Arat; Grzegorz Basak; Anastasia Pouli; Charles Crawley; Keith M O Wilson; Herve Tilly; Jennifer Byrne; Claude Eric Bulabois; Jakob Passweg; Zubeyde Nur Ozkurt; Wilfried Schroyens; Bruno Lioure; Mercedes Colorado Araujo; Xavier Poiré; Gwendolyn Van Gorkom; Gunhan Gurman; Liesbeth C de Wreede; Patrick J Hayden; Meral Beksac; Stefan O Schönland; Ibrahim Yakoub-Agha Journal: Bone Marrow Transplant Date: 2022-02-15 Impact factor: 5.483