Hematopoietic stem cell mobilization with intravenous melphalan and G-CSF in patients with chemoresponsive multiple myeloma: Report of a phase II trial

S. Gupta, P. Zhou, H. Hassoun, T. Kewalramani, L. Reich, S. Costello, L. Drake, V. Klimek, M. Dhodapkar, J. Teruya-Feldstein, C. Hedvat, N. Kalakonda, M. Fleisher, D. Filippa, J. Qin, S. D. Nimer, R. L. Comenzo

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Multiple myeloma (MM) is an incurable hematologic malignancy for which autologous hematopoietic stem cell transplantation (HCT) is a standard therapy. The optimal method of stem cell mobilization is not defined. We evaluated intravenous melphalan (60 mg/m2), the most effective agent for MM, and G-CSF (10 μg/kg/day) for mobilization. End points were safety, adequacy of CD34 + collections, MM response, and contamination of stem cell components (SCC). In total, 32 patients were mobilized. There were no deaths or significant bleeding episodes; 14 patients (44%) required hospitalization for neutropenic fever. Median days of grade 3 or 4 neutropenia or thrombocytopenia were 7 (2-20) and 8 (3-17). Median mobilization days, CD34 + cells/kg and total leukaphereses were 16 (12-30), 12.1 million (2.6-52.8), and 2 (1-5) respectively. Four patients (12.5 %) failed to achieve the target of 4 million CD34 + cells/kg in five leukaphereses. Reduction in myeloma was seen in 11 patients (34%) with 3 (9%) achieving complete response; 15 (47%) maintained prior responses. Estimated MM contamination per SCC (N=48) was 0.0009% (range 0-0.1) and 0.21 × 10 4 cells per kg (range 0-41.2). Increased contamination was associated with increased patient age. This strategy for mobilization is feasible, frequently requires hospitalization and transfusion, and controls disease in most patients.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalBone Marrow Transplantation
Volume35
Issue number5
DOIs
StatePublished - Mar 1 2005
Externally publishedYes

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Gupta, S., Zhou, P., Hassoun, H., Kewalramani, T., Reich, L., Costello, S., Drake, L., Klimek, V., Dhodapkar, M., Teruya-Feldstein, J., Hedvat, C., Kalakonda, N., Fleisher, M., Filippa, D., Qin, J., Nimer, S. D., & Comenzo, R. L. (2005). Hematopoietic stem cell mobilization with intravenous melphalan and G-CSF in patients with chemoresponsive multiple myeloma: Report of a phase II trial. Bone Marrow Transplantation, 35(5), 441-447. https://doi.org/10.1038/sj.bmt.1704779