title: Chemomobilization with Etoposide is Highly Effective in Patients with Multiple Myeloma and Overcomes the Effects of Age and Prior Therapy.
abstract: The optimal mobilization strategy prior to autologous stem cell transplantation for patients with multiple myeloma remains unclear. Mobilization with cytokines alone appears to yield suboptimal results in older patients as well as patients who have received prior lenalidomide. To avoid the marked cytopenias and risks of hemorrhagic cystitis associated with the administration of cyclophosphamide, we investigated the efficacy and safety of chemomobilization with an intermediate dose etoposide (VP-16; 375 mg/m(2) on days +1 and +2) and granulocyte-colony stimulating factor (G-CSF) (5 μg/kg twice daily from day +3 through the final day of collection). We reviewed our institutional experience with 152 myeloma patients mobilized with this regimen. The addition of VP-16 to G-CSF resulted in successful mobilization in 100% of patients, including 143 (94%) who collected successfully in a single day. A total of 99% of patients, including those with prior XRT and/or prior lenalidomide or thalidomide therapy, collected at least 5 × 10(6) cells/kg in 1 or 2 days of apheresis, and the median total number of CD34(+) cells collected in the entire population was 12 × 10(6) cells/kg. Collection was predictable, with 61% of patients collecting on day +11, and the rest between days +7 and +13. There were no variables, including age, prior imid exposure, radiation therapy, or total amount of prior therapy that were associated with suboptimal mobilization. Adverse effects of the regimen included supportive transfusions required in 31 (20%) patients, and fevers requiring hospitalization or intravenous antibiotics in 26 (17%) patients. VP-16 and G-CSF appears to be a safe and effective mobilization regimen for patients with multiple myeloma undergoing autologous stem cell transplantation, producing excellent stem cell yield with the majority of patients requiring 1 day of apheresis.
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel, North Carolina 27599-7305, USA. wwood@unch.unc.edu
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.forename: Julia
authors.initials: J
authors.lastname: Whitley
authors.forename: Dominic
authors.initials: D
authors.lastname: Moore
authors.forename: Andrew
authors.initials: A
authors.lastname: Sharf
authors.forename: Robert
authors.initials: R
authors.lastname: Irons
authors.forename: Kamakshi
authors.initials: K
authors.lastname: Rao
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serody
authors.forename: Jay
authors.initials: J
authors.lastname: Coghill
authors.forename: Donald
authors.initials: D
authors.lastname: Gabriel
authors.forename: Thomas
authors.initials: T
authors.lastname: Shea
mesh_terms: D000367:Age Factors; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods; D002452:Cell Count; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide