Efficacy and safety of etoposide + cytarabine + pegfilgrastim mobilization regimen versus G-CSF mobilization regimen alone for hematopoietic stem cell mobilization in patients with multiple myeloma and lymphoma

Abstract

Background: Even with the tremendous progress made in treating multiple myeloma and lymphoma, autologous hematopoietic stem cell transplantation (ASCT) after high-dose chemotherapy is still an essential part of treatment. The mobilization of a sufficient number of high-quality peripheral blood stem cells (PBSC) is the main factor influencing the success of ASCT. However, further research is still needed to determine the best approach for hematopoietic stem cell mobilization.

Study design and methods: This retrospective, single-center study aimed to compare the efficacy and safety of hematopoietic stem cell mobilization between a combination regimen of etoposide, cytarabine, and pegfilgrastim (EAP) and granulocyte colony-stimulating factor (G-CSF) alone.

Results: The cohort comprised 52 patients assigned to the EAP mobilization protocol and 62 receiving G-CSF monotherapy. Compared with the G-CSF cohort, the EAP group demonstrated higher rates of prior exposure to multi-line chemotherapy (P=0.001), radiation therapy (P=0.018), and daratumumab therapy (P=0.006). Baseline demographic parameters showed no significant intergroup differences. The results indicated that EAP demonstrated superior efficacy in CD34⁺ cell yield optimization (P<0.001) and apheresis session reduction (P<0.001). However, this regimen was associated with increased infectious complications (P=0.003) and platelet transfusion requirements (P<0.001). Conversely, G-CSF monotherapy necessitated greater plerixafor utilization (P<0.001) and prolonged apheresis duration (P=0.002). Post-transplant hematological recovery analysis revealed accelerated platelet engraftment in the EAP cohort (P=0.037).

Discussion: The EAP regimen demonstrated significantly enhanced mobilization efficiency compared to the G-CSF monotherapy while maintaining an acceptable toxicity profile. These findings suggest that the EAP regimen may represent a superior alternative for mobilizing hematopoietic stem cells in patients with multiple myeloma or lymphoma.

Keywords: EAP; hematopoietic stem cell; lymphoma; mobilization; multiple myeloma.