Article

Peripheral blood progenitor cell collections in multiple myeloma: Predictors and management of inadequate collections

University of Toronto, Toronto, Ontario, Canada
British Journal of Haematology (Impact Factor: 4.96). 10/2003; 93(1):142 - 145. DOI: 10.1046/j.1365-2141.1996.448987.x

ABSTRACT Thirty-seven patients with previously treated multiple myeloma (MM) underwent peripheral blood progenitor cell (PBPC) collection following high-dose cyclophosphamide and GM-CSF or sequential IL-3 and GM-CSF. Patients with an inadequate collection were considered for a second or third collection. 25 patients underwent subsequent autotransplant. The only variable predictive of CFU-GM yield was the extent of prior melphalan therapy. All repeat collections were unsuccessful and patients infused with an autograft obtained from multiple sets of collections had a high incidence of delayed engraftment. We conclude that melphalan should be avoided or PBPC collection performed early in the disease course in patients who are potential transplant candidates.

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    • "HEAVILY PRETREATED PATIENTS HAVE A LOWER PBSC YIELD Many studies proved that prior radiotherapy and chemotherapy with alkylating agents (melphalan, carmustine) adversely affect mobilization (Watts et al, 1997; Clark & Brammer, 1998; Ketterer et al, 1998; Marit et al, 1998; Russell et al, 1998; Perea et al, 2001). Melphalan is particularly stem-cell toxic and even a low dose given orally before mobilization results in reduced CD34 + cell mobilization (Tricot et al, 1995; Prince et al, 1996; Demirer et al, 1997; Goldschmidt et al, 1997; Boccadoro et al, 2002). Fludarabine pretreatment was proven in several studies to be associated with poor PBSC mobilization (e.g. "
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    • "In patients, biological responses to G-CSF vary widely. These differences are partly explained by prior chemotherapy (Haas et al, 1994; Breems et al, 1996; Prince et al, 1996), but in patients who have undergone apparently equally cytotoxic treatments and even in healthy volunteers or normal mice, wide variations in mobilization responses have also been noted (Roberts et al, 1995b,1997; Hasegawa et al 2000). Conceivably, such variation may be caused by different clearance rates for pharmacological substances in general that vary from individual to individual and, in fact, are the focus of many current pharmacogenomic approaches (Housman & Ledley, 1998). "
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