Associate Professor University of Debrecen Debrecen, Hungary
Introduction: Autologous peripheral stem cell transplantation (APSCT) is still a crucial part of the therapy in eligible multiple myeloma (MM) patients. The gold standard of stem cell mobilization is administering high-dose cyclophosphamide followed by granulocyte colony stimulating factor (G-CSF), however the usage of G-CSF alone can also be an effective option
Methods: Our aim was to compare the efficacy and safety of solo G-CSF versus chemotherapy-based stem cell mobilization in our Hungarian patient population.
Results: We reviewed 210 patients’ data who underwent stem cell mobilization between 2018 and 2022. Solo G-CSF was administered in 104 cases while 106 patients received chemotherapy (cyclophosphamide or VTD-PACE regimen) which was followed by the cytokine stimulation. In the solo G-CSF group, there was a significantly higher need for plerixafor administration (45% vs 13%, p< 0.001), unsuccessful stem cell mobilization was more frequent (11% vs 3%, p=0.024) and the mean amount of collected stem cells was significantly lower (6.9 vs. 9.8 x 106/bwkg, p< 0.001) than in the chemotherapy group. On the other hand, infections were less frequent (4% vs 27%, p< 0.001) and the number of days spent in hospital was significantly lower (6 vs 14 days, p< 0.001). The number of therapy lines before stem cell collection had no effect on any of the outcomes. Plerixafor was more frequenty administered in those who received lenalidomide or daratumumab as part of the induction therapy than in those who were treated by other regimens (41% vs 23%, p=0.007 and 78% vs 2 %, p< 0.001, respectively). The amount of collected stem cells was negatively influenced by previous lenalidomide therapy (p < 0.001) and there was a marked, but not significant difference in the ratio of unsuccessful mobilization attempts (11.3% vs 4.3%, p=0.056). Interestingly, R-ISS stages and treatment responses had no impact on the efficacy of the mobilization procedure.
Conclusions: The administration of solo G-CSF is a safe method of stem cell mobilization, however the higher rate of plerixafor administration and unsuccessful attempts may question its cost-effectivity.
