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Original

Intermediate-dose CY and G-CSF more efficiently mobilize adequate numbers of PBSC for tandem autologous PBSC transplantation compared with low-dose CY in patients with multiple myeloma

, , , , &
Pages 539-547 | Published online: 07 Jul 2009
 

Abstract

Background

Autologous PBSC transplantation is the standard care for patients with multiple myeloma. The most common regimen used to mobilize PBSC consists of CY and G-CSF.

Methods

We retrospectively analyzed the efficacy and toxicity of two regimens of CY for PBSC mobilization: low-dose CY (1–2 g/m2, LD-CY, n=61) plus G-CSF, and intermediate-dose CY (3–4 g/m2, ID-CY, n=26) plus G-CSF.

Results

In the LD-CY group, 5.17 (0.23–17.3)×106 CD34+ cells/kg, and in the ID-CY group 7.71 (0.08–26.4)×106 CD34+ cells/kg (P=0.018), were collected. Although ≥2×106/kg CD34+ cells were collected in 89% of the LD-CY group and 92% of the ID-CY group, this was achieved after a single leukapheresis in 54% of the LD-CY group and 92% of the ID-CY group (P=0.0001). Patients who are to have tandem autologous PBSC transplants require ≥4×106/kg CD34+ cells. This was achieved in only 65% patients in the LD-CY group but 88% in the ID-CY group (P=0.05). Among patients who had not had prior melphalan and/or >12 months of prior treatment, 74% in the LD-CY group and 100% in ID-CY group mobilized ≥4x106/kg CD34+ cells. Febrile neutropenia was more frequent in the ID-CY group (38% vs. 13%).

Discussion

In conclusion, compared with LD-CY, patients receiving ID-CY were more likely to collect a total CD34+ cell number adequate for tandem autologous PBSC transplantation. The increased toxicity was manageable and considered acceptable.

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