Bortezomib and cyclophosphamide based chemo-mobilization in multiple myeloma
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ORIGINAL ARTICLE
Bortezomib and cyclophosphamide based chemo‑mobilization in multiple myeloma Bhausaheb Bagal1,5 · Anant Gokarn1,5 · Sachin Punatar1,5 · Shashank Das1 · Avinash Bonda1,5 · Lingaraj Nayak1,5 · Akanksha Chichra1,5 · Sadhana Kannan2,5 · Libin J. Mathew1 · Prashant Tembhare3,5 · Nikhil Patkar3,5 · Minal Poojary4,5 · Shashank Ojha4,5 · Papagudi Ganesan Subramanian3,5 · Sumeet Gujral3,5 · Navin Khattry1,5 Received: 8 July 2020 / Revised: 4 August 2020 / Accepted: 16 August 2020 © Japanese Society of Hematology 2020
Abstract Hematopoietic stem and progenitor cell (HSPC) mobilization regimens in multiple myeloma typically use filgrastim (GCSF) alone or combination of GCSF with plerixafor or high-dose cyclophosphamide. Murine model and human studies have shown HSPC mobilization potential of bortezomib. A total of 37 patients underwent mobilization using bortezomib 1.3 mg/m2 on day 1, 4, 8 and 11, cyclophosphamide 1 g/m2 on day 8 and 9, and GCSF 10 μg/kg from day 10 (B-Cy-GCSF). This regimen was compared with our earlier cohort of patients where cyclophosphamide was given at dose of 1 g/m2 on day 1 and day 2 followed by GCSF 10 μg/kg from day 4 (Cy-GCSF). In B-Cy-GCSF group, median CD34 cells collected were 9.21 × 106/kg (range 4.95–17.1) while in the Cy-GCSF cohort, the median CD34 cell yield was 8.2 × 106/kg (0.4–24.2). Target CD34 cells yield of 5 × 106/kg was achieved with single apheresis in 58.6% of patients after B-Cy-GCSF mobilization as compared to 44.3% in Cy-GCSF group (p = 0.07). Three patients failed mobilization after Cy-GCSF, while no patients failed mobilization in bortezomib group. Addition of bortezomib to Cy-GCSF mobilization showed a trend towards increased CD34 collection and reduced need for apheresis sessions. Keywords Multiple myeloma · Stem cell mobilization · Bortezomib
Background ASCT remains a standard consolidation measure in patients with multiple myeloma, as it is associated with improved progression free [1, 2] and overall survival [3, 4]. This is especially relevant in developing countries where access to novel agents is limited and options are limited for relapsed refractory patients. With increasing access to ASCT [5], * Navin Khattry [email protected] 1
Department of Medical Oncology, CRC, ACTREC, Tata Memorial Centre, 3rd floor, Paymaster Shodhika, Navi Mumbai, Maharashtra 410210, India
2
Department of Biostatistics, ACTREC, Tata Memorial Centre, Mumbai, India
3
Department of Hematopathology, Tata Memorial Centre, Mumbai, India
4
Department of Transfusion Medicine, ACTREC, Tata Memorial Centre, Mumbai, India
5
Homi Bhabha National Institute, Mumbai, India
adequate HSPC harvest, a sine qua non for ASCT remains an essential and indispensable step. Stem cells are usually mobilized to peripheral blood using GCSF with or without chemotherapy, referred to as chemo-mobilization and steady state mobilization, respectively. With improvements in harvest methods such as large volume apheresis [6] and advent of plerixafor [7], mobilization failures are encounte
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