PURPOSE: To compare, in the setting of tandem autotransplantations for multiple myeloma (MM), two established methods of peripheral-blood stem-cell (PBSC) procurement with chemotherapy or hematopoietic growth factor alone. PATIENTS AND METHODS: Between June 1994 and July 1995, 44 patients with MM were randomized to PBSC mobilization with either granulocyte colony-stimulating factor (G-CSF) 16 microg/kg (group 1; n = 22) or high-dose cyclophosphamide (HDCTX) 6 g/m2 plus G-CSF 5 microg/kg (group 2; n = 22). All 44 patients received melphalan 200 mg/m2 with their first autograft and 32 patients proceeded to a second transplantation. RESULTS: Group 2 required a significantly longer time interval for completion of PBSC collection than group 1 (median, 22 v 8 days; P = .0001), greater frequency of hospitalization (100% v 32%; P = .0001), and increased transfusion of platelets (86% v 18%; P = .0001) and packed RBCs (86% v 55%; P = .02). Likewise, the incidence of fever and pneumonia/sepsis were higher in group 2 (P = .02 and P = .04, respectively). Surprisingly, despite greater CD34 cell quantities infused in group 2, median recovery times of granulocytes (both > 500/microL and 2,500/microL) and platelets (both > 50,000/microL and > 100,000/microL) were similar (all P > .7). Posttransplant toxicities were also similar. CONCLUSION: Compared with HDCTX plus G-CSF, high-dose G-CSF alone is associated with lower morbidity, shorter duration of PBSC mobilization, and comparable hematopoietic recovery after transplantation, which should result in significant cost reduction. Considering the relatively limited antitumor activity of HDCTX (10% with > or = 50% tumor cytoreduction), PBSC mobilization with HDCTX should be limited to selected patients with persistent MM despite induction chemotherapy.
RCT Entities:
PURPOSE: To compare, in the setting of tandem autotransplantations for multiple myeloma (MM), two established methods of peripheral-blood stem-cell (PBSC) procurement with chemotherapy or hematopoietic growth factor alone. PATIENTS AND METHODS: Between June 1994 and July 1995, 44 patients with MM were randomized to PBSC mobilization with either granulocyte colony-stimulating factor (G-CSF) 16 microg/kg (group 1; n = 22) or high-dose cyclophosphamide (HDCTX) 6 g/m2 plus G-CSF 5 microg/kg (group 2; n = 22). All 44 patients received melphalan 200 mg/m2 with their first autograft and 32 patients proceeded to a second transplantation. RESULTS: Group 2 required a significantly longer time interval for completion of PBSC collection than group 1 (median, 22 v 8 days; P = .0001), greater frequency of hospitalization (100% v 32%; P = .0001), and increased transfusion of platelets (86% v 18%; P = .0001) and packed RBCs (86% v 55%; P = .02). Likewise, the incidence of fever and pneumonia/sepsis were higher in group 2 (P = .02 and P = .04, respectively). Surprisingly, despite greater CD34 cell quantities infused in group 2, median recovery times of granulocytes (both > 500/microL and 2,500/microL) and platelets (both > 50,000/microL and > 100,000/microL) were similar (all P > .7). Posttransplant toxicities were also similar. CONCLUSION: Compared with HDCTX plus G-CSF, high-dose G-CSF alone is associated with lower morbidity, shorter duration of PBSC mobilization, and comparable hematopoietic recovery after transplantation, which should result in significant cost reduction. Considering the relatively limited antitumor activity of HDCTX (10% with > or = 50% tumor cytoreduction), PBSC mobilization with HDCTX should be limited to selected patients with persistent MM despite induction chemotherapy.
Authors: M Mohty; K Hübel; N Kröger; M Aljurf; J Apperley; G W Basak; A Bazarbachi; K Douglas; I Gabriel; L Garderet; C Geraldes; O Jaksic; M W Kattan; Z Koristek; F Lanza; R M Lemoli; L Mendeleeva; G Mikala; N Mikhailova; A Nagler; H C Schouten; D Selleslag; S Suciu; A Sureda; N Worel; P Wuchter; C Chabannon; R F Duarte Journal: Bone Marrow Transplant Date: 2014-03-31 Impact factor: 5.483
Authors: A Antar; Z K Otrock; M A Kharfan-Dabaja; H A Ghaddara; N Kreidieh; R Mahfouz; A Bazarbachi Journal: Bone Marrow Transplant Date: 2015-03-09 Impact factor: 5.483
Authors: Matthew J Rees; Peter Mollee; Jun Yen Ng; Alex Murton; Jose Filipe Gonsalves; Ashish Panigrahi; Hayley Beer; Joanna Loh; Philip Nguyen; Sam Hunt; Hayden Jina; Rebecca Wayte; Gaurav Sutrave; Jocelyn Tan; Chathuri Abeyakoon; Ashlyn Chee; Bradley Augustson; Akash Kalro; Cindy Lee; Shivam Agrawal; Leonid Churilov; Chong Chyn Chua; Andrew Boon Ming Lim; Daniela Zantomio; Andrew Grigg Journal: Bone Marrow Transplant Date: 2021-04-28 Impact factor: 5.483
Authors: Tomer Mark; Jessica Stern; Jessica R Furst; David Jayabalan; Faiza Zafar; April LaRow; Roger N Pearse; John Harpel; Tsiporah Shore; Michael W Schuster; John P Leonard; Paul J Christos; Morton Coleman; Ruben Niesvizky Journal: Biol Blood Marrow Transplant Date: 2008-07 Impact factor: 5.742