2022 EBMT Voice of China Prolonged cyclophosphamide infusion time as a stem cell mobilization regimen for NDMM patients is more effective: a retrospective single-center study

Cyclophosphamide (Cy) combined with colony-stimulating factor (G-CSF) is usually selected for peripheral blood stem cell mobilization in myeloma patients
.

The First Affiliated Hospital of Sun Yat-Sen University conducted a study to evaluate the efficacy and safety of two different infusion times of Cy + G-CSF for peripheral blood stem cell mobilization in patients with newly diagnosed multiple myeloma (NDMM)
.

Research Methods The study included NDMM patients who received G-CSF mobilization and autologous hematopoietic stem cell transplantation (ASCT) in the First Affiliated Hospital of Sun Yat-sen University from September 2008 to May 2020.
A retrospective analysis of "24-hour continuous infusion" (24 hour group) and "short time (4-6 hours) infusion" (control group) mobilization effect and safety of cyclophosphamide
.

A total of 156 patients were included, 68 in the 24-hour group and 88 in the control group.
The demographic characteristics of the two groups were similar, including gender, age, hemoglobin, percentage of plasma cells, myeloma type, cytogenetic risk, and international stage.
Systematic (ISS) staging and serum creatinine, serum calcium, lactate dehydrogenase levels
.

• Median collection of CD34+ cells: 6.
78 x 106/kg and 4.
48 x 106/kg in the 24-hour and control groups, respectively (p < 0.
0001, Figure 1)
.

Figure 1 • Average number of apheresis: 2.
26 in the 24-hour group and 1.
51 in the control group (p < 0.
0001)
.

• Median CD34+ cells in the first collection: 11.
57×106/kg and 4.
79×106/kg in the 24-hour group and the control group (2 vs 45), respectively (p=0.
493)
.

• Median second apheresis of CD34+ cells: 8.
04 x 106/kg and 4.
16 x 106/kg in the 24-hour group and the control group (49 vs 40), respectively (p < 0.
0001)
.

• Median CD34+ cells at third apheresis: 4.
53 x 106/kg and 3.
23 x 106/kg in the 24-hour group and the control group (14 vs 2), respectively (p=0.
427)
.

• Achievement of the target amount of CD34+ cell collection (defined as ≥6×106/kg): 55.
9% and 29.
9% of patients in the 24-hour group and control group, respectively (p=0.
001, Figure 2)
.

Figure 2 • Proportion requiring secondary mobilization and bone marrow transplantation: 1.
5% in the 24-hour group and 14.
8% in the control group (p=0.
004, Figure 3)
.

Figure 3 • Time to neutrophil engraftment: 10 days for the 24-hour group and 11 days for the control group (p < 0.
0001)
.

• Platelet engraftment time: 11 days in the 24-hour group and 12 days in the control group (p=0.
272)
.

• There were no significant differences in hematologic toxicity, non-hematologic toxicity and hospitalization costs between the two groups
.

CONCLUSIONS: Cyclophosphamide 24-hour continuous infusion is effective in stem cell mobilization in newly diagnosed multiple myeloma patients, with similar toxicity to short-term infusion, and it can be considered in MM patients planning for a second or third transplant
.

References: Y.
Li, M.
Chen, J.
Liu, et al.
PROLONGED INFUSION TIME OF CYCLOPHOSPHAMIDE IS MORE EFFECTIVE AS A STEM CELL MOBILIZATION REGIMEN IN NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS: A RETROSPECTIVE MONOCENTRIC REPORT.
EBMT P055.
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