Prolonged infusion time of cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) as a mobilization regimen may improve mobilization efficiency in newly diagnosed multiple myeloma patients: a single center experience

Figures & data

Table 1. Patients’ demographic features.

Characteristics	24-h group	Control group
	n = 68	n = 88	P
Age, median (IQR), years	56 (47-60)	52 (44-59)	0.056
Sex (n, %)			0.925
Male	42 (62)	55(63)
Female	26 (38)	33 (37)
Type of myeloma (n, %)			0.969
IgG	35 (51)	46 (52)
IgA	16 (24)	19 (22)
IgD	3 (4)	3 (3)
Light chains only	14 (21)	20 (23)
Serum creatinine, median (IQR), μmol/L	89.5 (67-256.5)	82.0 (65-184.2)	0.256
Serum calcium, median (IQR), mmol/L	2.4 (2.2-2.6)	2.4 (2.2-2.5)	0.944
Hemoglobin, median (IQR), g/L	100 (83-118)	96 (77-117)	0.655
Plasma cells percentage, median (IQR), %	22 (12-36)	24 (13-40)	0.376
International staging system (n, %)			0.152
I	19 (28)	30 (34)
II	26 (38)	40 (46)
III	23 (34)	17 (19)
Missing	0 (0)	1 (1)
Induction regimens (n, %)			< 0.001
VD^a	1 (1)	34 (39)
PAD^b	67 (99)	54 (61)
Response after induction (n, %)			0.105
VGPR or better	59 (87)	66 (75)
PR	8 (12)	16 (18)
SD	1 (1)	6 (6)
Number of apheresis, median (IQR)	2 (2-3)	1 (1-2)	<0.001

Table 2. Stem cell mobilization efficacy.

Variables	24-h group n = 68	Control group n = 88	p
CD34+ cell yield, median (IQR), ×10^6/kg	6.78 (3.59-11.69)	4.48 (2.39-6.30)	<0.001
CD34+ cell yield on each day of apheresis, median (IQR), ×10^6/kg
Day 1	1.88 (0.89-4.64)	2.47 (1.08-4.89)	0.389
Day 2	3.74 (1.87-6.54)	2.18 (0.84-3.70)	0.001
Day 1 + Day 2	6.50 (2.87-11.15)	4.20 (2.39-6.30)	0.002
Maximum CD34+ cell yield by single apheresis, median (IQR), ×10^6/kg	4.31 (2.07-7.18)	3.28 (1.89-5.17)	0.031
Patients meeting optimal cell numbers (n, %)
≥2 × 10^6 CD34+/kg	62 (91)	71 (81)	0.067
≥4 × 10^6 CD34+/kg	51 (75)	45 (51)	0.002
≥6 × 10^6 CD34+/kg	38 (56)	26 (30)	0.001
≥8 × 10^6 CD34+/kg	27 (40)	10 (11)	<0.001
Day of leukapheresis initiation, median (IQR), days	10 (9-10)	9 (9-10)	0.345
No. of patients requiring secondary mobilization and bone marrow transplant (n, %)	1 (1)	13 (15)	0.004

Figure 1. Multivariate analysis.

Table 3. Toxicity during stem cell mobilization.

Toxicity profiles^a	Any grade			Grade 3 or 4
	24-h group n = 68	Control group n = 88	p	24-h group n = 68	Control group n = 88	p
Non-hematological
Nausea/emesis (n, %)	32 (47)	40 (45)	0.842	9 (13)	6 (7)	0.178
Abdominal pain/diarrhea (n, %)	15 (22)	23 (26)	0.556	3 (4)	3 (3)	0.999
Pneumonia (n, %)	6 (9)	6 (7)	0.641	4 (6)	5 (6)	0.999
Mucositis (n, %)	0 (0)	2 (2)	0.505	0 (0)	0 (0)	n.s.
Septicemia (n, %)	0 (0)	2 (2)	0.505	0 (0)	2 (2)	0.505
Seizure (n, %)	0 (0)	1 (1)	0.999	0 (0)	0	n.s.
Hemorrhagic cystitis (n, %)	0 (0)	3 (3)	0.342	0 (0)	0	n.s.
Hematological
Neutropenia (n, %)	68 (100)	88 (100)	n.s.	66 (97)	87 (99)	0.821
Thrombocytopenia (n, %)	56 (82)	70 (80)	0.736	22 (32)	30 (34)	0.819
	24-h group n = 68		Control group n = 88		p
Duration of neutropenia, median (IQR), days	2 (1-3)		3 (2-4)		0.038
Leukocyte nadir, median (IQR), ×10^9/L	0.33 (0.21-0.57)		0.54 (0.26-0.79)		0.012
Neutropenic fever (n, %)	11 (16)		18 (20)		0.539
Platelet transfusion (n, %)	15 (22)		21 (24)		0.791
Erythrocyte transfusion (n, %)	3 (4)		2 (2)		0.769

Abbreviation: n.s. = no significance.

^a Toxicity profiles were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) 5.0.

Table 4. Hematologic recovery after ASCT.

	24-h group n = 68	Control group n = 88	p
Treatment plan (n, %)			< 0.001
Standard melphalan (200 mg/m^2)	7 (10)	73 (83)
CVB regimen	55 (81)	11 (13)
Dose-reduced melphalan (140 mg/m^2)	6 (9)	2 (2)
bortezomib plus melphalan	0 (0)	2 (2)
Transplanted CD34+ cell yield, median (IQR), ×10^6/kg	3.35 (2.52-6.61)	3.23 (2.18-5.08)	0.063
Day of reach, median (IQR), days
Neutrophil > 0.5	10 (9-11)	11 (10-12)	< 0.001
PLT > 20	11 (10-13)	12 (10-14)	0.272

Data availability statement

The authors confirm that data supporting the findings of this study are available within the article.