title: Stem Cell Harvesting after Bortezomib-Based Reinduction for Myeloma Relapsing after Autologous Transplantation: Results from the British Society of Blood and Marrow Transplantation/United Kingdom Myeloma Forum Myeloma X (Intensive) Trial.
abstract: The phase III British Society of Blood and Marrow Transplantation/United Kingdom Myeloma Forum Myeloma X trial (MMX) demonstrated prospectively, for the first time, superiority of salvage autologous stem cell transplantation over chemotherapy maintenance for multiple myeloma (MM) in first relapse after previous ASCT. However, many patients have stored insufficient stem cells (PBSC) for second ASCT and robust evidence for remobilization after first ASCT is lacking. We report the feasibility, safety, and efficacy of remobilization after bortezomib-doxorubicin-dexamethasone reinduction in MMX and outcomes of second ASCT with these cells. One hundred ten patients underwent ≥1 remobilization with 32 and 4, undergoing second and third attempts, respectively. Toxicities of remobilization were similar to those seen in first-line mobilization. After all attempts, 52% of those with insufficient previously stored PBSC had harvested a sufficient quantity to proceed to second ASCT. Median PBSC doses infused, neutrophil engraftment, and time to discharge after second ASCT were similar regardless of stem cell source, as were the toxicities of second ASCT. No significant differences between PBSC sources were noted in depth of response to ASCT or time to progression. Harvesting after bortezomib-doxorubicin-dexamethasone reinduction for MM at first relapse is safe and feasible and yields a reliable cell product for second ASCT. The study is registered with ClinicalTrials.gov (NCT00747877) and EudraCT (2006-005890-24).
authors.affiliation: Section of Experimental Haematology, Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parrish
authors.affiliation: Department of Heamatology, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Curly T C M
authors.initials: CTCM
authors.lastname: Morris
authors.affiliation: Department of Heamatology, Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Williams
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Cairns
authors.affiliation: Department of Heamatology, St Bartholomew's Hospital, London, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Cavenagh
authors.affiliation: Department of Heamatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: John A
authors.initials: JA
authors.lastname: Snowden
authors.affiliation: Department of Heamatology, Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Ashcroft
authors.affiliation: Department of Heamatology, The Christie NHS Foundation Trust, & University of Manchester, Manchester, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Cavet
authors.affiliation: Department of Heamatology, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hunter
authors.affiliation: Department of Haematology, University Hospitals Bristol, Bristol, United Kingdom.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Bird
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Chalmers
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Brown
authors.affiliation: Department of Haematology, University College Hospitals, London, United Kingdom.
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.affiliation: Department of Haematology, King's College Hospital, London, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: Schey
authors.affiliation: Department of Haematology, Gloucester Royal Hospital, Gloucester, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Chown
authors.affiliation: Section of Experimental Haematology, Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, United Kingdom. Electronic address: g.cook@leeds.ac.uk.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
mesh_terms: D000069286:Bortezomib / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods* / Q000592:standards; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007937:Leukapheresis / Q000592:standards*; D060046:Maintenance Chemotherapy / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D012074:Remission Induction / Q000379:methods; D016879:Salvage Therapy / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin
keywords: Myeloma; Stem cell mobilization; Stem cell transplant