title: Stem cell mobilization chemotherapy with gemcitabine is effective and safe in myeloma patients with bortezomib-induced neurotoxicity.
abstract: Vinorelbine chemotherapy with granulocyte-colony stimulating factor (G-CSF) stimulation is a widely applied non-myelosuppressive mobilization regimen in Switzerland for myeloma patients, but its neurotoxic potential limits its use in patients with bortezomib-induced polyneuropathy. In this single-center study, we alternatively evaluated safety and effectiveness of gemcitabine chemotherapy with G-CSF for mobilization of autologous stem cells. Between March 2012 and February 2013, all bortezomib-pretreated myeloma patients planned to undergo first-line high-dose melphalan chemotherapy received a single dose of 1250 mg/m2 gemcitabine, with G-CSF started on day 4. The 24 patients in this study had received a median of four cycles of bortezomib-dexamethason-based induction. Bortezomib-related polyneuropathy was identified in 21 patients (88%) by clinical evaluation and a standardized questionnaire. Administration of gemcitabine mobilization did not induce new or aggravate pre-existing neuropathy. Stem cell mobilization was successful in all 24 patients, with a single day of apheresis being sufficient in 19 patients (78%). The median yield was 9.51×10(6) CD34+ cells/kg. Stem collection could be accomplished at day 8 in 67%. Our data suggest that single-dose gemcitabine together with G-CSF is an effective mobilization regimen in myeloma patients and a safe alternative non-myelosuppressive mobilization chemotherapy for myeloma patients with bortezomib-induced polyneuropathy.
authors: a Department of Clinical Research , University of Berne , Berne , Switzerland.
authors: Beatrice U
authors: BU
authors: Mueller
authors: b Department of Medical Oncology , University Hospital of Berne , Berne , Switzerland.
authors: Sandra
authors: S
authors: Keller
authors: a Department of Clinical Research , University of Berne , Berne , Switzerland.
authors: Katja
authors: K
authors: Seipel
authors: c Department of Hematology, University Hospital of Berne , Berne , Switzerland.
authors: Behrouz
authors: B
authors: Mansouri Taleghani
authors: d Department of Oncology , Kantonsspital , Thun , Switzerland.
authors: Daniel
authors: D
authors: Rauch
authors: e Department of Oncology , Kantonsspital , Fribourg , Switzerland and.
authors: Daniel
authors: D
authors: Betticher
authors: f Department of Oncology , Kantonsspital , Solothurn , Switzerland.
authors: Thomas
authors: T
authors: Egger
authors: b Department of Medical Oncology , University Hospital of Berne , Berne , Switzerland.
authors: Thomas
authors: T
authors: Pabst
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069286:Bortezomib / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011115:Polyneuropathies / Q000139:chemically induced; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D003841:Deoxycytidine; D016179:Granulocyte Colony-Stimulating Factor; D000069286:Bortezomib; D000093542:Gemcitabine
keywords: Autologous; bortezomib; gemcitabine; mobilization; myeloma; neurotoxicity; polyneuropathy; stem cells; transplant