Plerixafor on-demand in association with low-dose cyclophosphamide and G-CSF in the mobilization of patients with multiple myeloma: High effectiveness, low toxicity, and affordable cost

摘要

In CD34+ cells mobilization of patients with multiple myeloma (MM), the use of Cyclophosphamide (CTX) at a dose of 2?g/m2has low efficacy although also lower toxicity. The suboptimal mobilizing effect of low-dose CTX, however, may be overcome by plerixafor (PLX) on demand.We conducted a prospective multicenter study in 138 patients with MM to evaluate CTX 2?g/m2in association with granulocyte-colony stimulating factor (G-CSF) and on-demand PLX. We compared results with a historical group of MM patients (n?=?138) mobilized using CTX at a dose of 4?g/m2.CD34+ cells greater than 2?×?106/kg in max three aphereses were harvested in 98.6% of patients in the on-demand PLX study group while in 84.0% in the historical group, (p?=?0.0001). In the on-demand-PLX study group, a successful harvest greater than 5?×?106/kg in max three aphereses was observed in 85.5% of patients versus 62.3% of patients in the historical control group, (p=0.0001). In the on-demand-PLX study group, 4.3% (6/138) of patients had febrile complications. Salvage mobilization in the on-demand PLX study group was 1.4%.In conclusions, on-demand PLX?+?CTX 2?g/m2?+?G-CSF 10?μg/kg has higher efficacy and lower toxicity compared with CTX 4?g/m2?+?G-CSF. An analysis of costs is presented.