title: Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma.
abstract: BACKGROUND
  Lenalidomide (LEN) is a relatively new and very effective therapy for multiple myeloma (MM). Prior LEN therapy is associated with an increased risk of peripheral blood stem cell collection (PBSC) failure, particularly with filgrastim (G-CSF) alone. We performed a retrospective chart review of 319 consecutive MM patients who underwent apheresis to collect PBSCs for the first autologous stem cell transplant (ASCT).
  
  
  RESULTS
  The median number of PBSCs collected in the LEN (+) group was significantly less than the LEN (-) group (6.34 vs. 7.52 × 10(6) CD34(+) cells/kg; p = 0.0004). In addition, the median number of apheresis sessions required for adequate PBSCs collection were significantly more in the LEN (+) group as compared to LEN (-) group (2 vs. 1 sessions; p = 0.002). In the LEN (+) group, there was a negative correlation between PBSCs collected and prior number of cycles of LEN (p = 0.0001). Rate of PBSC collection failure was 9% in the LEN (+) group and 5% in the LEN (-) group (p = 0.16). Only six patients who failed PBSC collection with G-CSF were able to collect adequate PBSCs with G-CSF + plerixafor. LEN exposure had no effect on neutrophil or platelet recovery post-ASCT.
  
  
  CONCLUSIONS
  Up to four cycles of LEN exposure have minimal negative impact on PBSC collection. Despite prolong exposure of LEN, PBSC collection was adequate for two ASCTs in the majority of patients and post-ASCT engraftment was not longer than expected; however, clinical relevance (complication rate, quality of life, cost) of prolonged LEN exposure on both PBSC and ASCT, should be evaluated in prospective clinical trials.
authors.affiliation: Department of Bone Marrow Transplantation, Karmanos Cancer Institute, 4100 John R, 4 HWCRC, Rm: 4257, Detroit, MI 48201, USA.
authors.forename: Divaya
authors.initials: D
authors.lastname: Bhutani
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Zonder
authors.forename: Jason
authors.initials: J
authors.lastname: Valent
authors.forename: Nishant
authors.initials: N
authors.lastname: Tageja
authors.forename: Lois
authors.initials: L
authors.lastname: Ayash
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Kadhimi
authors.forename: Judith
authors.initials: J
authors.lastname: Abrams
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lum
authors.forename: Voravit
authors.initials: V
authors.lastname: Ratanatharathorn
authors.forename: Joseph
authors.initials: J
authors.lastname: Uberti
authors.forename: Muneer H
authors.initials: MH
authors.lastname: Abidi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001781:Blood Component Removal; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D000069585:Filgrastim; D005938:Glucocorticoids / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000187:drug effects*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D011719:Pyrazines / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D005938:Glucocorticoids; D007155:Immunologic Factors; D011719:Pyrazines; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide; D000069585:Filgrastim