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The association of mobilising regimen on immune reconstitution and survival in myeloma patients treated with bortezomib, cyclophosphamide and dexamethasone induction followed by a melphalan autograft

Bone Marrow Transplantation volume 56, pages 2152–2159 (2021)Cite this article

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Abstract

G-CSF only mobilisation has been shown to enhance immune reconstitution early post-transplant, but its impact on survival remains uncertain. We undertook a retrospective review of 12 transplant centres to examine overall survival (OS) and time to next treatment (TTNT) following melphalan autograft according to mobilisation method (G-CSF only vs. G-CSF and cyclophosphamide [CY]) in myeloma patients uniformly treated with bortezomib, cyclophosphamide and dexamethasone induction. Six centres had a policy to use G-CSF alone and six to use G-CSF + CY. Patients failing G-CSF only mobilisation were excluded. 601 patients were included: 328: G-CSF + CY, 273: G-CSF only. Mobilisation arms were comparable in terms of age, Revised International Staging System (R-ISS) groups and post-transplant maintenance therapy. G-CSF + CY mobilisation generated higher median CD34 + yields (8.6 vs. 5.5 × 106/kg, p < 0.001). G-CSF only mobilisation was associated with a significantly higher lymphocyte count at day 15 post-infusion (p < 0.001). G-CSF only mobilisation was associated with significantly improved OS (aHR = 0.60, 95%CI 0.39–0.92, p = 0.018) and TTNT (aHR = 0.77, 95%CI 0.60–0.97, p = 0.027), when adjusting for R-ISS, disease-response pre-transplant, age and post-transplant maintenance therapy. This survival benefit may reflect selection bias in excluding patients with unsuccessful G-CSF only mobilisation or may be due to enhanced autograft immune cell content and improved early immune reconstitution.

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Acknowledgements

The authors would like to acknowledge the database managers; Julie-Ann Yallop and Jo Gardiner for assistance in data collection.

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Authors and Affiliations

  1. Department of Clinical Haematology, Austin Health, Melbourne, VIC, Australia

    Matthew J. Rees, Chong Chyn Chua, Andrew Boon Ming Lim, Daniela Zantomio & Andrew Grigg

  2. Department of Haematology, Princess Alexandra Hospital, and School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Peter Mollee & Jun Yen Ng

  3. Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia

    Alex Murton

  4. Department of Haematology, St Vincent’s Hospital, Melbourne, VIC, Australia

    Jose Filipe Gonsalves

  5. Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Ashish Panigrahi & Hayley Beer

  6. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia

    Joanna Loh & Philip Nguyen

  7. Department of Haematology, Eastern Health, Melbourne, VIC, Australia

    Sam Hunt & Hayden Jina

  8. Department of Clinical Haematology, Westmead Hospital, Sydney, NSW, Australia

    Rebecca Wayte & Gaurav Sutrave

  9. Department of Haematology, University Hospital Geelong, Geelong, VIC, Australia

    Jocelyn Tan & Chathuri Abeyakoon

  10. Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Ashlyn Chee & Bradley Augustson

  11. Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia

    Akash Kalro & Cindy Lee

  12. Department of Haematology, Princes of Wales Hospital, Sydney, NSW, Australia

    Shivam Agrawal

  13. Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia

    Leonid Churilov

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Rees, M.J., Mollee, P., Ng, J.Y. et al. The association of mobilising regimen on immune reconstitution and survival in myeloma patients treated with bortezomib, cyclophosphamide and dexamethasone induction followed by a melphalan autograft. Bone Marrow Transplant 56, 2152–2159 (2021). https://doi.org/10.1038/s41409-021-01300-2

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