High-dose cyclophosphamide with or without etoposide for mobilization of peripheral blood progenitor cells in patients with multiple myeloma: Efficacy and toxicity

I. Gojo, C. Guo, C. Sarkodee-Adoo, B. Meisenberg, A. Fassas, A. P. Rapoport, M. Cottler-Fox, M. Heyman, N. Takebe, G. Tricot

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of the study was to examine the yield of CD34+ cells, response rates, and toxicity of high-dose cyclophosphamide with or without etoposide in patients with multiple myeloma. In total, 77 myeloma patients received either cyclophosphamide 4.5 g/m2 (n=28) alone or with etoposide 2 g/m2 (n=49) in a nonrandomized manner, followed by G-CSF 10 μg/kg/day for the purpose of stem cell mobilization. The effects of various factors on CD34+ cell yield, response rate and engraftment were explored. A median of 22.39 × 106 CD34+ cells/kg were collected on the first day of leukapheresis (range 0.59-114.71 × 106/kg) in 71 (92%) of patients. Greater marrow plasma cell infiltration (P=0.02 or prior radiation therapy (P=0.02) adversely affected CD34+ cell yield. In total, 45% of patients receiving cyclophosphamide and 56% of those receiving cyclophosphamide/etoposide had at least a minimum response by EBMT criteria. In all, 25% of patients who received cyclophosphamide alone vs 75.5% of patients who received combined chemotherapy required hospitalization mainly for treatment of neutropenic fever. Cyclophosphamide alone is associated with impressive CD34+ cell yields and clear antimyeloma activity. The addition of etoposide resulted in increased toxicity without significant improvement in CD34+ cell yield or response rates.

Original languageEnglish (US)
Pages (from-to)69-76
Number of pages8
JournalBone marrow transplantation
Volume34
Issue number1
DOIs
StatePublished - Jul 2004

Keywords

  • Mobilization
  • Multiple myeloma
  • Peripheral blood stem cells

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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