Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma.
Lenalidomide is an agent that has shown great activity in patients with multiple myeloma (MM). However, studies have suggested that this drug negatively affects subsequent stem cell collection. To investigate whether lenalidomide impairs stem cell mobilization and collection, we reviewed data for patients with MM who underwent mobilization with filgrastim. Predictors of mobilization failure were evaluated using logistic regression analysis. In 26 (9%) of 302 myeloma patients, stem cell mobilization failed. Mobilization failed in 25% of patients who had previously received lenalidomide, compared with 4% of patients who had not received lenalidomide (P < .001). In a multivariate analysis, prior lenalidomide use (odds ratio: 5.9; 95% confidence interval [CI]: 2.4-14.3) and mobilization more than 1 year after diagnosis (odds ratio: 4.6; 95% CI: 1.9-11.1) were significantly associated with failed mobilization. Twenty-one of 26 patients in whom mobilization with filgrastim failed underwent remobilization with chemotherapy and filgrastim; in 18 (86%) of these 21 patients, stem cells were successfully mobilized and collected. In patients with multiple myeloma, prior lenalidomide therapy is associated with failure of stem cell mobilization with filgrastim. Remobilization with chemotherapy and filgrastim is usually successful in these patients.
Popat
Uday
U
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. upopat@mdanderson.org
Saliba
Rima
R
Thandi
Rupinderjit
R
Hosing
Chitra
C
Qazilbash
Muzaffar
M
Anderlini
Paolo
P
Shpall
Elizabeth
E
McMannis
John
J
Körbling
Martin
M
Alousi
Amin
A
Andersson
Borje
B
Nieto
Yago
Y
Kebriaei
Partow
P
Khouri
Issa
I
de Lima
Marcos
M
Weber
Donna
D
Thomas
Sheeba
S
Wang
Michael
M
Jones
Roy
R
Champlin
Richard
R
Giralt
Sergio
S
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001596:Benzylamines; D001853:Bone Marrow / Q000187:drug effects*; D003131:Combined Modality Therapy; D000080027:Cyclams; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000494:pharmacology; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000494:pharmacology; D000077269:Lenalidomide; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012307:Risk Factors; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014182:Transplantation, Autologous; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D013792:Thalidomide; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D000077269:Lenalidomide; D000069585:Filgrastim; C088327:plerixafor; D007069:Ifosfamide