ABSTRACT
Background: High dose Cyclophosphamide [Cy] and Vinorelbine Cyclophosphamide [Vino-Cy] are stem cell [SC] mobilisation options for patients with multiple myeloma [MM]. We present a comparison of mobilisation outcomes using these regimens
Patients and methods: Vino-Cy patients received Vinorelbine 25 mg/m[2] on day 1, cyclophosphamide 1500 mg/m[2] on day 2, and pegylated GCSF on day 4 or GCSF 10 mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000 mg/m[2] on day 1 and GCSF10 mcg/kg/day from day 5 onwards. The target CD34 + SC collection was 5 * 10[6] per kg/BW
Results: 149 patients were included. SC collection was lower in the Vino-Cy group [8.20 * 10[6]/ Kg BW] compared to the Cy group [11.43 * 10[6]/Kg BW], with adjusted geometric mean ratio of 0.59 [95% CI 0.41 to 0.86, p = 0.006]. Time taken to achieve an adequate PB SC count was shorter for Vino-Cy [9 +/- 1 day compared to 12 +/- 2 days for Cy, adjusted absolute mean difference -3.95, 95% CI -4.85 to -3.06, P < .001]. Mobilisation related toxicities [in particular, neutropaenic fever] were greater for Cy
Conclusion: Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity
ABSTRACT
Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment.