Stem cell mobilization chemotherapy with gemcitabine is effective and safe in myeloma patients with bortezomib-induced neurotoxicity

Abstract

Vinorelbine chemotherapy with granulocyte-colony stimulating factor (G-CSF) stimulation is a widely applied non-myelosuppressive mobilization regimen in Switzerland for myeloma patients, but its neurotoxic potential limits its use in patients with bortezomib-induced polyneuropathy. In this single-center study, we alternatively evaluated safety and effectiveness of gemcitabine chemotherapy with G-CSF for mobilization of autologous stem cells. Between March 2012 and February 2013, all bortezomib-pretreated myeloma patients planned to undergo first-line high-dose melphalan chemotherapy received a single dose of 1250 mg/m² gemcitabine, with G-CSF started on day 4. The 24 patients in this study had received a median of four cycles of bortezomib-dexamethason-based induction. Bortezomib-related polyneuropathy was identified in 21 patients (88%) by clinical evaluation and a standardized questionnaire. Administration of gemcitabine mobilization did not induce new or aggravate pre-existing neuropathy. Stem cell mobilization was successful in all 24 patients, with a single day of apheresis being sufficient in 19 patients (78%). The median yield was 9.51 × 10⁶ CD34+ cells/kg. Stem collection could be accomplished at day 8 in 67%. Our data suggest that single-dose gemcitabine together with G-CSF is an effective mobilization regimen in myeloma patients and a safe alternative non-myelosuppressive mobilization chemotherapy for myeloma patients with bortezomib-induced polyneuropathy.

Keywords:

• Autologous
• bortezomib
• gemcitabine
• mobilization
• myeloma
• neurotoxicity
• polyneuropathy
• stem cells
• transplant

Acknowledgements

We wish to thank Marion Bleckmann, Barbara Muster and Irene Briner for help with stem cell data collection, Myriam Legros for providing CD34+ data, and Anke Klingenberg-Rettich and Doris Jaeggi for help with data collection on clinical outcome.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

 This work was supported by a grant from the Bernische Stiftung für Klinische Krebsforschung #07-2014 (to TP), from the Krebsliga Bern #24-2013 (to TP), and from the EMPIRIS Foundation/Ursula-Hecht-Fonds #23-2015 (to TP).