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Peripheral blood stem cell mobilisation with G-CSF alone versus G-CSF and cyclophosphamide after bortezomib, cyclophosphamide and dexamethasone induction in multiple myeloma

Bone Marrow Transplantation volume 53, pages 1116–1123 (2018)Cite this article

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Abstract

Bortezomib-based induction is often used in transplant-eligible patients with myeloma. The optimal peripheral blood stem cell (PBSC) mobilisation strategy in this context is unclear. We reviewed the efficacy of G-CSF alone (G-alone) vs. G-CSF and cyclophosphamide (G-cyclo: standard dose: 1.5–2 g/m2; high dose: 3–4 g/m2) PBSC mobilisation strategies in 288 patients who only received bortezomib, cyclophosphamide and dexamethasone (VCD) induction prior to autograft across six apheresis centres from November 2012 to June 2017. ‘Uncomplicated successful mobilisation’ was defined as achieving a PBSC yield of ≥4 × 106/kg within two aphereses, without plerixafor or mobilisation-associated toxicity (predominantly febrile neutropenia, FN). Success rates were 84% in G-cyclo standard dose (6% FN), 64% in G-cyclo high dose (18% FN) and 69% in G-alone (plerixafor successfully salvaged 8/9 patients). Median total stem cell yield was significantly higher with G-cyclo, but not different between the two cyclophosphamide doses. Age greater than the median of 61 years was associated with higher failure rates (22 vs. 11%, p = 0.01) and lower PBSC yield, especially in the G-alone group. Prior radiotherapy exposure did not impact on collection success. Our observations suggest that both G-cyclo standard dose and G-alone are reasonable mobilisation strategies. The former may be preferred if salvage plerixafor is unavailable.

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Acknowledgements

We would like to acknowledge Ms Pina Polidano and Ms Narinder Kaur in helping with data acquisition.

Author contributions

CCC designed the study, acquired and analysed the data, and wrote the paper. HYL designed the study, acquired data and critically revised the paper. KLC, JO, SS, CW, MD, PC, JH, HK, CD, KB, SM, SG acquired data and critically revised the paper. AG designed the study, analysed the data and critically revised the paper.

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Authors and Affiliations

  1. Clinical Haematology, Austin Health, Heidelberg, VIC, Australia

    Chong Chyn Chua, Hui Yin Lim & Andrew Grigg

  2. Clinical Haematology, St Vincent’s Health, Fitzroy, VIC, Australia

    Khai Li Chai

  3. Integrated Haematology Department, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia

    Jeremy Ong, Shirlene Sim, Colin Wood, Michael Dickinson, Hayley King & Claire Dowsing

  4. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

    Michael Dickinson

  5. Clinical Haematology, Cancer Services Barwon Health– University Hospital, Geelong, VIC, Australia

    Philip Campbell & Jennifer Hempton

  6. Deakin University School of Medicine, Geelong, VIC, Australia

    Philip Campbell

  7. Clinical Haematology, Alfred Health-Monash University, Clayton, VIC, Australia

    Krystal Bergin

  8. Department of Haematology, Monash University Eastern Health Clinical School, Clayton, VIC, Australia

    Sharon Muir & Simon Gibbs

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  1. Chong Chyn Chua
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Correspondence to Chong Chyn Chua.

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Chua, C.C., Lim, H.Y., Chai, K.L. et al. Peripheral blood stem cell mobilisation with G-CSF alone versus G-CSF and cyclophosphamide after bortezomib, cyclophosphamide and dexamethasone induction in multiple myeloma. Bone Marrow Transplant 53, 1116–1123 (2018). https://doi.org/10.1038/s41409-018-0152-2

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