Improved progression-free and event-free survival in myeloma patients undergoing PBSCH receiving a cyclophosphamide + G-CSF regimen than G-CSF alone

Int J Hematol. 2018 May;107(5):559-567. doi: 10.1007/s12185-018-2408-4. Epub 2018 Jan 31.

Abstract

Two regimens are commonly used for peripheral blood hematopoietic stem cell harvesting (PBSCH) in multiple myeloma: high-dose cyclophosphamide (HD-CY) + granulocyte-colony stimulating factor (G-CSF), and G-CSF alone. The objective of the present study was to evaluate the anti-myeloma effect of the PBSCH regimen including HD-CY. We retrospectively assessed harvesting efficiency, complications, and anti-myeloma effects in 115 patients receiving HD-CY + G-CSF (HD-CY group) and 32 patients receiving G-CSF alone (G-alone group). We collected > 2 × 106 CD34-positive cells/kg from 93 and 75% of patients in the HD-CY and G-alone groups, respectively (P = 0.0079). The mean HSC count was also higher in the HD-CY group. No severe complications were observed in the G-alone group, whereas 66% of patients in the HD-CY group were treated with intravenous antibiotics. The median progression-free and event-free survival (PFS and EFS) were longer in the HD-CY group than in the G-alone group (28 vs. 18 months and 25 vs. 13 months, respectively; P = 0.0127 and 0.0139), with no difference in median overall survival. HD-CY showed anti-myeloma effect, as verified by prolonged EFS and PFS, when a vincristine, doxorubicin, and dexamethasone regimen was administered as induction before PBSCH.

Keywords: Cyclophosphamide; G-CSF; Mobilization; Multiple myeloma.

MeSH terms

  • Antigens, CD34
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cell Count
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage*
  • Dexamethasone / administration & dosage
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Drug Therapy, Combination
  • Female
  • Granulocyte Colony-Stimulating Factor / administration & dosage*
  • Hematopoietic Stem Cells
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Induction Chemotherapy
  • Male
  • Middle Aged
  • Multiple Myeloma / mortality*
  • Multiple Myeloma / therapy*
  • Peripheral Blood Stem Cell Transplantation*
  • Pulse Therapy, Drug
  • Retrospective Studies
  • Time Factors
  • Vincristine / administration & dosage

Substances

  • Antigens, CD34
  • Immunosuppressive Agents
  • Granulocyte Colony-Stimulating Factor
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide