title: Blood graft cellular composition and posttransplant outcomes in myeloma patients mobilized with or without low-dose cyclophosphamide: a randomized comparison.
abstract: Autologous stem cell transplantation is a standard treatment in multiple myeloma (MM). Blood grafts are usually collected after mobilization with granulocyte-colony-stimulating factor (G-CSF) alone or in a combination with cyclophosphamide (CY). There is limited knowledge of the possible effects of different mobilization regimens on blood graft characteristics and posttransplant outcomes.
  
  
  
  Thirty-eight patients with MM were included in this study. The patients were randomly assigned at registration to mobilization with either low-dose CY plus G-CSF (Arm A) or G-CSF alone (Arm B) and received three cycles of lenalidomide, bortetzomib, and dexamethasone induction. Flow cytometry analysis of lymphocyte subsets in the blood grafts after cryopreservation was performed. Hematologic and immune recovery were evaluated up to 12 months posttransplant.
  
  
  
  The blood grafts in Arm A contained significantly more CD34+ cells but in Arm B there was a greater proportion of CD34+CD38- cells and higher numbers of T and B lymphocytes as well as natural killer (NK) cells. The engraftment was comparable but lymphocyte count at 15 days posttransplant was higher in Arm B (0.8 × 10(9) /L vs. 0.5 × 10(9) /L, p = 0.033). At 3 and 6 months posttransplant the total number of NK cells was also higher in G-CSF-mobilized patients. There was no difference in progression-free survival between the study arms.
  
  
  
  CY plus G-GSF yields more CD34+ cells but seems to diminish lymphocyte and NK cell counts in the grafts and hampers immune recovery after transplantation. Thus G-CSF alone might be a preferred mobilization method due to more rapid immune recovery posttransplant.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Valtola
authors.affiliation: Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Silvennoinen
authors.affiliation: Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Ropponen
authors.affiliation: Department of Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Siitonen
authors.affiliation: Department of Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Säily
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Sankelo
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Venla
authors.initials: V
authors.lastname: Terävä
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Mervi
authors.initials: M
authors.lastname: Putkonen
authors.affiliation: Finnish Medicines Agency.
authors.forename: Taru
authors.initials: T
authors.lastname: Kuittinen
authors.affiliation: Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.|Laboratory Center of Eastern Finland, Kuopio, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Pelkonen
authors.affiliation: Laboratory Center of Eastern Finland, Kuopio, Finland.
authors.forename: Pentti
authors.initials: P
authors.lastname: Mäntymaa
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.|University of Turku, Turku, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Remes
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Varmavuo
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D064592:Autografts / Q000166:cytology*; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide