Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 27:12:825550.
doi: 10.3389/fonc.2022.825550. eCollection 2022.

High Efficacy of Stem Cell Mobilization With Etoposide+Cytarabine Plus G-CSF in Patients With Multiple Myeloma

Zhijuan Zhu  1 , Xiaofan Li  1   2 , Yiping Liu  1 , Ping Chen  1 , Xianling Chen  1 , Hua Li  1 , Jiafu Huang  1 , Yuanzhong Chen  1   2 , Nainong Li  1   2
Affiliations

High Efficacy of Stem Cell Mobilization With Etoposide+Cytarabine Plus G-CSF in Patients With Multiple Myeloma

Zhijuan Zhu et al. Front Oncol. .

Abstract

Background: Efficient mobilization of CD34+ hematopoietic stem cells plays a vital role in successful autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM), especially in cases with high-risk cytogenetic recommended for tandem ASCT. However, the optimal mobilization strategy remains a matter of debate in the era of lenalidomide. The combination of etoposide with Cytarabine plus G-CSF as a novel mobilization regimen in MM has not been reported previously.

Methods: This research retrospectively studied mobilization efficacy and safety using etoposide combined with Cytarabine (etoposide 50-100 mg/m2, qd d1-3; AraC 0.5 g/m2, q12h d1~3) plus G-CSF (5 µg/kg/day, from d5 until the day of apheresis) in 128 patients with MM. 70(54.7%) patients received lenalidomide-based induction regimens treatment.

Results: A median of 27.75×106 CD34+ cells/kg was collected in the first apheresis, and 28.23×106 CD34+ cells/kg were collected overall. Of the 128 patients, all achieved adequate collection (≥2×106 CD34+ cells/kg), 121(94.5%) achieved optimal collection for single ASCT (≥5×106 CD34+ cells/kg), and 114(89.1%) harvested optimal collection for tandem ASCT (≥10×106 CD34+ cells/kg). In particular, the target yield of optimal collection for tandem ASCT was reached in 82.8% (106/128) by a single apheresis procedure. 14 patients obtained deeper response post mobilization. In multivariate analysis, cycles of prior chemotherapy independently affected the optimal achievement of CD34+ cells (p=0.004, OR 0.695, 95% CI 0.544~0.888). Previous lenalidomide exposure did not significantly impair CD34+ cells collection. Although 68% episodes of antibiotic usage were observed, no severe infection or treatment-related mortality occurred.

Conclusion: Stem cell mobilization with Etoposide + Cytarabine plus G-CSF was highly efficient and safe in patients with MM, which could be considered in high-risk MM patients who were referred for tandem ASCT.

Keywords: Cytarabine; Etoposide; granulocyte colony-stimulating factor; multiple myeloma; stem cell mobilization.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Similar articles

See all similar articles

Cited by

References

    1. Moreau P, San Miguel J, Sonneveld P, Mateos M, Zamagni E, Avet-Loiseau H, et al. . Multiple Myeloma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Ann Oncol (2017) 28:iv52–61. doi: 10.1093/annonc/mdx096 - DOI - PubMed
    1. Kumar S, Callander N, Adekola K, Anderson L, Baljevic M, Campagnaro E, et al. . Multiple Myeloma, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw: JNCCN (2020) 18(12):1685–717. doi: 10.6004/jnccn.2020.0057 - DOI - PubMed
    1. Gagelmann N, Eikema D, Koster L, Caillot D, Pioltelli P, Lleonart J, et al. . Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma With Extramedullary Disease and High-Risk Cytogenetics: A Study From the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant (2019) 25(11):2134–42. doi: 10.1016/j.bbmt.2019.07.004 - DOI - PubMed
    1. Brioli A, Perrone G, Patriarca F, Pezzi A, Nobile F, Ballerini F, et al. . Successful Mobilization of PBSCs Predicts Favorable Outcomes in Multiple Myeloma Patients Treated With Novel Agents and Autologous Transplantation. Bone Marrow Transplant (2015) 50(5):673–8. doi: 10.1038/bmt.2014.322 - DOI - PubMed
    1. Moreb JS, Byrne M, Shugarman I, Zou F, Xiong S, May WS, et al. . Poor Peripheral Blood Stem Cell Mobilization Affects Long-Term Outcomes in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation. J Clin Apher (2018) 33(1):29–37. doi: 10.1002/jca.21556 - DOI - PubMed

LinkOut - more resources