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 25â¯mg/m2 on day 1, cyclophosphamide 1500â¯mg/m2 on day 2, and pegylated GCSF on day 4 or GCSF 10â¯mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000â¯mg/m2 on day 1 and GCSF10â¯mcg/kg/day from day 5 onwards. The target CD34â¯+â¯SC collection was 5â¯×â¯106â¯per kg/BW. RESULTS: 149 patients were included. SC collection was lower in the Vino-Cy group (8.20â¯×â¯106/Kg BW) compared to the Cy group (11.43â¯×â¯106/Kg BW), with adjusted geometric mean ratio of 0.59 (95% CI 0.41 to 0.86, pâ¯=â¯0.006). Time taken to achieve an adequate PB SC count was shorter for Vino-Cy (9⯱â¯1â¯day compared to 12⯱â¯2â¯days for Cy, adjusted absolute mean difference -3.95, 95% CI -4.85 to -3.06, Pâ¯<â¯.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.
Subject(s)
Cyclophosphamide/administration & dosage , Hematopoietic Stem Cell Mobilization/methods , Multiple Myeloma/therapy , Peripheral Blood Stem Cells , Vinorelbine/administration & dosage , Autografts , Cyclophosphamide/adverse effects , Female , Filgrastim , Humans , Male , Middle Aged , Multiple Myeloma/blood , Peripheral Blood Stem Cell Transplantation , Vinorelbine/adverse effectsABSTRACT
Peripheral blood stem cells (PBSC) have become the most common source of hematopoietic cells for allogeneic or autologous blood and marrow transplantation (BMT). We performed an evaluation of PBSC collections using three different apheresis systems in two major transplantation centers in Singapore. Patients undergoing autologous BMT and donors collecting for allogeneic BMT were harvested using the COBE Spectra, Haemonetics MCS+, or Baxter Amicus. There were 99 Spectra collections (61 were autologous), 81 MCS+ collections (35 were autologous) and 38 Amicus collections (33 were autologous). Our data shows that the Amicus not only processed larger peripheral blood volumes but also yielded larger PBSC volume (P-value<0.05). In terms of PBSC products, the Spectra produced more WBC, WBC/liter blood processed, and WBC/kg (P-value<0.05). The Spectra and MCS+ produced comparable amount of CD34+ cells. Amicus collected 50% less platelets compared to Spectra and MCS+. The total CD34+ cells in the PBSC products was linearly correlated to the circulating CD34+ cells using Spectra, MCS+, and Amicus. Our results suggest that, compared to MCS+ and Amicus, collecting PBSC using the COBE Spectra can produce more WBC with a similar number of CD34+ cells. With a linear correlation of circulating CD34+ cells to the total CD34+ cells in the products, the availability of an automated procedure, no rotating seal, and a small extracorporeal volume, the Spectra appears to be the preferred machine for PBSC collection.