title: Cyclophosphamide-based stem cell mobilization in relapsed multiple myeloma patients: A subgroup analysis from the phase III trial ReLApsE.
abstract: OBJECTIVE
  Analysis of the efficiency and toxicity of cyclophosphamide-based stem cell mobilization in patients with relapsed multiple myeloma (RMM).
  
  
  METHODS
  Peripheral blood stem cells (PBSCs) were mobilized with high dose cyclophosphamide (2 g/m2daily on days 1 and 2) and G-CSF plus pre-emptive/rescue plerixafor in RMM patients (first to third relapse) treated within the ReLApsE trial of the German-Speaking Myeloma Multicenter Group (GMMG).
  
  
  RESULTS
  Mobilization was initiated with high-dose cyclophosphamide (HD-CY) and G-CSF in 30 patients. Fifteen patients received additional pre-emptive/rescue administration of plerixafor. Stem cell collection was successful (≥2×106CD34+ cells per kg bw) in 77% (23/30 patients). Patients with prior high-dose melphalan collected a significantly lower median total number of PBSCs than patients without prior high-dose melphalan (3.3×106vs 17×106CD34+ cells/kg bw). Toxicity of HD-CY was frequent with 12 serious adverse events (SAE) in 37% of patients (11/30 patients). Infections accounted for the majority of SAE reports. In two patients, SAEs were lethal (septic shock).
  
  
  CONCLUSIONS
  These data proof feasibility of PBSC collection at relapse but emphasize the importance of collection and storage of additional PBSC transplants during first-line treatment when mobilization is more efficient and less toxic.
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Marc-Andrea
authors.identifier: http://orcid.org/0000-0002-4000-6904
authors.initials: MA
authors.lastname: Baertsch
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Schlenzka
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Lisenko
authors.affiliation: Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Krzykalla
authors.affiliation: Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Becker
authors.affiliation: Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Weisel
authors.affiliation: Hematology, University Hospital Essen, Essen, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Noppeney
authors.affiliation: Hematology and Oncology, Goethe University, Frankfurt, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Martin
authors.affiliation: Hematology and Oncology, Kath. Krankenhaus Hagen gem. GmbH - St.-Marien-Hospital, Hagen, Germany.
authors.forename: Hans W
authors.initials: HW
authors.lastname: Lindemann
authors.affiliation: Hematology, Oncology and Stem Cell Transplantation, Klinikum Chemnitz GmbH, Chemnitz, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Haenel
authors.affiliation: Internal Medicine III, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Nogai
authors.affiliation: Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.affiliation: Hematology, Oncology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Salwender
authors.affiliation: Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Duesseldorf, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Fenk
authors.affiliation: Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Graeven
authors.affiliation: Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Reimer
authors.affiliation: Hematology and Oncology, Helios-Hospital Berlin Buch, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt-Hieber
authors.affiliation: Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Goerner
authors.affiliation: Center for Integrated Oncology, Med. Klinik III, University Hospital Bonn, Bonn, Germany.
authors.forename: Ingo G H
authors.initials: IGH
authors.lastname: Schmidt-Wolf
authors.affiliation: Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klein
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.|National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.|Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wuchter
mesh_terms: D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology* / Q000628:therapy*; D000072916:Peripheral Blood Stem Cells / Q000166:cytology / Q000187:drug effects / Q000378:metabolism; D012008:Recurrence; D061665:Time-to-Treatment; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide
keywords: bone marrow transplantation; clinical trials; multiple myeloma