title: High-dose cyclophosphamide with or without etoposide for mobilization of peripheral blood progenitor cells in patients with multiple myeloma: efficacy and toxicity.
abstract: The purpose of the study was to examine the yield of CD34(+) cells, response rates, and toxicity of high-dose cyclophosphamide with or without etoposide in patients with multiple myeloma. In total, 77 myeloma patients received either cyclophosphamide 4.5 g/m(2) (n=28) alone or with etoposide 2 g/m(2) (n=49) in a nonrandomized manner, followed by G-CSF 10 microg/kg/day for the purpose of stem cell mobilization. The effects of various factors on CD34(+) cell yield, response rate and engraftment were explored. A median of 22.39 x 10(6) CD34(+) cells/kg were collected on the first day of leukapheresis (range 0.59-114.71 x 10(6)/kg) in 71 (92%) of patients. Greater marrow plasma cell infiltration (P=0.02) or prior radiation therapy (P=0.02) adversely affected CD34(+) cell yield. In total, 45% of patients receiving cyclophosphamide and 56% of those receiving cyclophosphamide/etoposide had at least a minimum response by EBMT criteria. In all, 25% of patients who received cyclophosphamide alone vs 75.5% of patients who received combined chemotherapy required hospitalization mainly for treatment of neutropenic fever. Cyclophosphamide alone is associated with impressive CD34(+) cell yields and clear antimyeloma activity. The addition of etoposide resulted in increased toxicity without significant improvement in CD34(+) cell yield or response rates.
authors.affiliation: Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. igojo@umm.edu
authors.forename: I
authors.initials: I
authors.lastname: Gojo
authors.forename: C
authors.initials: C
authors.lastname: Guo
authors.forename: C
authors.initials: C
authors.lastname: Sarkodee-Adoo
authors.forename: B
authors.initials: B
authors.lastname: Meisenberg
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: A P
authors.initials: AP
authors.lastname: Rapoport
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: M
authors.initials: M
authors.lastname: Heyman
authors.forename: N
authors.initials: N
authors.lastname: Takebe
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D005047:Etoposide / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods* / Q000592:standards; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D003520:Cyclophosphamide