Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens.
The past decade has witnessed a paradigm shift in the initial treatment of multiple myeloma with the introduction of novel agents such as thalidomide, lenalidomide, and bortezomib, leading to improved outcomes. High-dose therapy and autologous stem cell transplantation remains an important therapeutic option for patients with multiple myeloma eligible for the procedure. Before the advent of the novel agents, patients underwent stem cell collection prior to significant alkylating agent exposure, given its potential deleterious effect on stem cell collection. With increasing use of the novel agents in the upfront setting, several reports have emerged raising concerns about their impact on the ability to collect stem cells. An expert panel of the International Myeloma Working Group (IMWG) was convened to examine the implications of these therapies on stem collection in patients with myeloma and to develop recommendations for addressing these issues. Here we summarize the currently available data and present our perspective on the problem and potential options to overcome this problem. Specifically, we recommend early mobilization of stem cells, preferably within the first 4 cycles of initial therapy, in patients treated with novel agents and encourage participation in clinical trials evaluating novel approaches to stem cell mobilization.
Kumar
Shaji
S
Division of Hematology, Mayo Clinic, Rochester, MN 55906, USA. kumar.shaji@mayo.edu
Giralt
Sergio
S
Stadtmauer
Edward A
EA
Harousseau
Jean L
JL
Palumbo
Antonio
A
Bensinger
William
W
Comenzo
Raymond L
RL
Lentzsch
Suzanne
S
Munshi
Nikhil
N
Niesvizky
Ruben
R
San Miguel
Jesus
J
Ludwig
Heinz
H
Bergsagel
Leif
L
Blade
Joan
J
Lonial
Sagar
S
Anderson
Kenneth C
KC
Tosi
Patrizia
P
Sonneveld
Pieter
P
Sezer
Orhan
O
Vesole
David
D
Cavo
Michele
M
Einsele
Hermann
H
Richardson
Paul G
PG
Durie
Brian G M
BG
Rajkumar
S Vincent
SV
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D003245:Consensus Statements as Topic; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000077269:Lenalidomide; D008495:Medical Oncology / Q000379:methods*; D009101:Multiple Myeloma / Q000628:therapy*; D011719:Pyrazines / Q000627:therapeutic use*; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide