title: Fractionated stem cell infusions for patients with plasma cell myeloma undergoing autologous hematopoietic cell transplantation.
abstract: We conducted a phase II trial investigating the impact of fractionated hematopoietic cell infusions on engraftment kinetics and symptom burden in patients with plasma cell myeloma (PCM) undergoing autologous hematopoietic cell transplant (AHCT). We hypothesized that multiple hematopoietic cell infusions would reduce duration of neutropenia and enhance immune recovery resulting in a better tolerated procedure. Twenty-six patients received high-dose melphalan followed by multiple cell infusions (Days 0, +2, +4, +6) and were compared to PCM patients (N = 77) who received high-dose melphalan and a single infusion (Day 0) (concurrent control group). The primary endpoint was number of days with ANC <500K/mcL. Symptom burden was assessed using the MSK-modified MD Anderson Symptom Inventory. Median duration of neutropenia was similar in study (4 days, range 3-5) and control patients (4 days, range 3-9) (p = 0.654). There was no significant difference in the number of red cell or platelet transfusions, days of fever, diarrhea, antibiotics, number of documented infections, or length of admission. Symptom burden surveys showed that AHCT was well-tolerated in both study and control patients. We conclude that fractionated stem cell infusions following high-dose melphalan do not enhance engraftment kinetics or significantly alter patients' clinical course following AHCT in PCM.
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Heather
authors.initials: H
authors.lastname: Landau
authors.affiliation: c University of Chicago , Chicago , IL , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wood
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: David J
authors.initials: DJ
authors.lastname: Chung
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Guenther
authors.initials: G
authors.lastname: Koehne
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Lendvai
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Hani
authors.initials: H
authors.lastname: Hassoun
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Alexander
authors.initials: A
authors.lastname: Lesokhin
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hoover
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;
authors.forename: Sean M
authors.initials: SM
authors.lastname: Devlin
authors.affiliation: a Memorial Sloan Kettering Cancer Center , New York , NY , USA ;|b Weill Cornell Medical Center , New York , NY , USA ;
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D016913:Blood Component Transfusion; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery*; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009503:Neutropenia / Q000097:blood* / Q000517:prevention & control; D009504:Neutrophils / Q000502:physiology*; D010865:Pilot Projects; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan
keywords: Engraftment; fractionated; myeloma; symptom burden; transplant