Etoposide + cytarabine + pegfilgrastim versus cyclophosphamide + G-CSF for stem cell mobilization in patients with poorly mobilized multiple myeloma and lymphoma

Abstract

Background: In multiple myeloma (MM) or lymphoma with poor mobilization, the combination of etoposide, cytarabine (Ara-C), and pegfilgrastim (EAP) appears to have higher mobilization efficacy than cyclophosphamide (Cy) plus granulocyte colony-stimulating factor (G-CSF) (CG) regimens. The purpose of this study was to examine whether there were differences in efficacy and toxicity between the two mobilization regimens.

Methods: All data were collected from Department of Hematology at the Affiliated People's Hospital of Ningbo University from May 2016 to March 2023. And data from EAP regimen were compared with data from the CG regimen.

Results: A total of 43 patients were mobilized by the EAP regimen and 44 patients by the CG regimen. The target yield of 2 × 10⁶ CD34⁺ cells/kg was achieved in 95.3 % (EAP) and 63.6 % (CG) of patients by 1.3 and 1.6 apheresis (means), respectively. In addition, 76.7 % of patients with EAP regimen and 29.5 % of patients with CG regimen achieved optimal mobilization (≥5 ×10⁶ CD34⁺ cells/kg) during the first apheresis session. The median number of cumulative collected CD34⁺ cells was 8.9 (range 2.6-41.3) × 10⁶ CD34⁺ cells/kg and 4.2 (range 0.1-18.8) × 10⁶ CD34⁺ cells/kg in the two groups, respectively. Thrombocytopenia gr. 4 was observed in 34.9 % of patients after EAP (CG, 2.3 %) and neutropenia gr. 4 was observed in 58.1 % of patients after EAP (CG, 63.6 %).

Discussion: EAP is an excellent mobilization regimen with acceptable toxicity and could be considered in patients with MM and lymphoma with poor mobilization.

Keywords: Autologous stem cell transplant; EAP; Lymphoma; Multiple myeloma; Poorly mobilizing.