title: Effect of chemotherapy with alkylating agents on the yield of CD34+ cells in patients with multiple myeloma. Results of the Spanish Myeloma Group (GEM) Study.
abstract: OBJECTIVE
  Although alkylating agents are clearly beneficial in multiple myeloma (MM), their deleterious effect on bone marrow hematopoietic progenitor cells usually precludes their use as front-line therapy in patients scheduled to undergo autologous stem cell transplantation (ASCT). We analyzed the impact of first-line chemotherapy with alkylating agents on stem cell collection in MM patients.
  
  
  METHODS
  Seven hundred and eighty-nine patients included in the Spanish multicenter protocol GEM-2000 underwent mobilization therapy after four courses of alternating VBMCP/VBAD chemotherapy.
  
  
  RESULTS
  The mobilization regimens consisted of standard or high-dose granulocyte colony-stimulating factor (G-CSF) in 551 (70%) patients, and chemotherapy and G-CSF in 206 (26%) patients. The CD34+ cell yield was lower than 4x10(6)/kg in 388 patients (49%), and equal or greater than 4x10(6)/kg in 401 patients (51%). Multivariate analysis indicated that advanced age (p<0.0001) and longer interval between diagnosis and mobilization (p=0.012) were the two variables associated with a lower CD34+ cell yield. Significant differences in CD34+ cell yield were not observed between the mobilization regimens. Of the 789 patients included in the protocol, 726 (92%) underwent the planned ASCT, whereas 25 (3%) patients did not because of the low number of CD34+ cells collected. Following ASCT, 0.5x10(9) neutrophils/L could be recovered after 11 days (median time; range, 5-71 days) and 20x10(9) platelets/L could be recovered after 12 days (median time; range, 6-69 days).
  
  
  CONCLUSIONS
  A short-course of therapy with alkylating agents according to the GEM-2000 protocol was associated with an appropriate CD34+ cell collection, and allowed the planned ASCT to be performed in the majority of MM patients.
authors.affiliation: Grupo Español de Mieloma. delarubia_jav@gva.es
authors.forename: Javier
authors.initials: J
authors.lastname: de la Rubia
authors.forename: Joan
authors.initials: J
authors.lastname: Bladé
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: Josep M
authors.initials: JM
authors.lastname: Ribera
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez
authors.forename: Adrián
authors.initials: A
authors.lastname: Alegre
authors.forename: José
authors.initials: J
authors.lastname: García-Laraña
authors.forename: Pascual
authors.initials: P
authors.lastname: Fernández
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Felipe
authors.initials: F
authors.lastname: de Arriba
authors.forename: Dolores
authors.initials: D
authors.lastname: Carrera
authors.forename: Joan
authors.initials: J
authors.lastname: Besalduch
authors.forename: Raimundo
authors.initials: R
authors.lastname: García Boyero
authors.forename: Luis
authors.initials: L
authors.lastname: Palomera Bernal
authors.forename: Miguel T
authors.initials: MT
authors.lastname: Hernández
authors.forename: Paz Ribas
authors.initials: PR
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Pérez-Calvo
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcalá
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Casado
authors.forename: Jesús
authors.initials: J
authors.lastname: San Miguel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D018906:Antineoplastic Agents, Alkylating / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001772:Blood Cell Count; D002330:Carmustine / Q000008:administration & dosage / Q000494:pharmacology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000494:pharmacology; D003907:Dexamethasone / Q000008:administration & dosage / Q000494:pharmacology; D004317:Doxorubicin / Q000008:administration & dosage / Q000494:pharmacology; D004334:Drug Administration Schedule; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation; D011241:Prednisone / Q000008:administration & dosage / Q000494:pharmacology; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D018952:Antigens, CD34; D018906:Antineoplastic Agents, Alkylating; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone