Andrew J Cowan1, Philip A Stevenson2, Damian J Green1, Sherilyn Tuazon1, Edward N Libby1, Mary Kwok3, Sarah Lee1, David G Coffey1, Ajay K Gopal1, Leona A Holmberg4. 1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle WA, USA; Seattle Cancer Care Alliance, Seattle, WA, USA. 2. Clinical Biostatistics, Fred Hutch, Seattle, WA. 3. Seattle Cancer Care Alliance, Seattle, WA, USA; Division of Hematology, Department of Medicine, University of Washington, Seattle WA, USA. 4. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle WA, USA; Seattle Cancer Care Alliance, Seattle, WA, USA. Electronic address: lholmber@fredhutch.org.
Abstract
BACKGROUND: Since the introduction of lenalidomide into induction therapy for multiple myeloma (MM), there have been conflicting reports about its impact on autologous peripheral blood stem cell (PBSC) mobilization. OBJECTIVE: We evaluated the impact of prior lenalidomide exposure in a large cohort of MM patients undergoing mobilization and collection at a tertiary stem cell transplant center. We hypothesized that collection of PBSCs is feasible even with prolonged duration of prior lenalidomide therapy. STUDY DESIGN: We examined patients with MM who attempted stem cell mobilization and collection, seen at our center between January 2012 and July 2015. The patients were categorized into 3 groups for analysis: 1) Those patients with prior receipt of > 6 cycles lenalidomide, 2) Those patients with prior receipt of ≤ 6 cycles of lenalidomide, and 3) Patients without prior lenalidomide exposure. We compared collection yields and days of apheresis amongst the 3 groups using linear regression analysis. RESULTS: We identified 297 patients with MM who underwent mobilization of PBSCs. Of these, 35 received > 6 cycles of lenalidomide (median of 8 cycles, range of 7 - 25), 156 received ≤ 6 cycles of lenalidomide (median of 4 cycles, range 1 - 6), and 106 had received no lenalidomide (Table 1). Prior lenalidomide exposure did not have a statistically significant impact on the absolute number of CD34+ cells collected, nor the length of collection based on a multivariate linear regression analysis for association between receipt of > 6 cycles of lenalidomide. CONCLUSION: In this retrospective analysis of MM patients undergoing autologous PBSC, we show that duration of prior lenalidomide exposure does not impact the total number of PBSC collected or the number of days of apheresis. These data suggest that longer courses of induction therapy with lenalidomide-containing regimens to achieve a maximum response can be safe without impairing the ability to collect PBSC, and that limiting lenalidomide use pre-mobilization does not appear warranted in all cases.
BACKGROUND: Since the introduction of lenalidomide into induction therapy for multiple myeloma (MM), there have been conflicting reports about its impact on autologous peripheral blood stem cell (PBSC) mobilization. OBJECTIVE: We evaluated the impact of prior lenalidomide exposure in a large cohort of MMpatients undergoing mobilization and collection at a tertiary stem cell transplant center. We hypothesized that collection of PBSCs is feasible even with prolonged duration of prior lenalidomide therapy. STUDY DESIGN: We examined patients with MM who attempted stem cell mobilization and collection, seen at our center between January 2012 and July 2015. The patients were categorized into 3 groups for analysis: 1) Those patients with prior receipt of > 6 cycles lenalidomide, 2) Those patients with prior receipt of ≤ 6 cycles of lenalidomide, and 3) Patients without prior lenalidomide exposure. We compared collection yields and days of apheresis amongst the 3 groups using linear regression analysis. RESULTS: We identified 297 patients with MM who underwent mobilization of PBSCs. Of these, 35 received > 6 cycles of lenalidomide (median of 8 cycles, range of 7 - 25), 156 received ≤ 6 cycles of lenalidomide (median of 4 cycles, range 1 - 6), and 106 had received no lenalidomide (Table 1). Prior lenalidomide exposure did not have a statistically significant impact on the absolute number of CD34+ cells collected, nor the length of collection based on a multivariate linear regression analysis for association between receipt of > 6 cycles of lenalidomide. CONCLUSION: In this retrospective analysis of MMpatients undergoing autologous PBSC, we show that duration of prior lenalidomide exposure does not impact the total number of PBSC collected or the number of days of apheresis. These data suggest that longer courses of induction therapy with lenalidomide-containing regimens to achieve a maximum response can be safe without impairing the ability to collect PBSC, and that limiting lenalidomide use pre-mobilization does not appear warranted in all cases.