MOBILIZATION POTENTIAL OF PATIENTS WITH LYMPHOMAS AND MULTIPLE MYELOMA INVOLVED IN ASCT
Abstract
Abstract:
Introduction: High-dose chemotherapy by following autologous stem cell transplant (ASCT) is a standard treatment of multiple myeloma (MM), relapse of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphomas (NHL). Monitoring of clinical and biochemical characteristics, as well as post-transplant parameters points to the importance of mobilization potential.
Aim: To evaluate the association of early recovery of neutrophil granulocytes ≥0.5 x 109/L after 11 days of transplantation (ANC500_11), platelets ≥20 x 109/L after 13 days of transplantation (PLT20_13) with clinical stage, duration of mobilization, as well as number of mobilization attempts, therapeutic response and dose CD34+ cells in the apheresis product.
Material and Methods: The retrospective study included 100 patients, of which 51 patients with MM, 27 with NHL and 22 with HL, in the period from November 2015, ending December 2018.
Results: The average age of the patient was 49.8 years. According to the DSS, 69% were in IIIA, while 12.5% of patients were in the IIIB clinical stage. According to the Ann-Arbor staging 92% patients were in the II or III clinical stage. The average number of CD34+ cells in the apheresis product was 8.3x106/kgBM. In the first attempt mobilization on average was 6.49±1.3 days. Engraftment is most often detected during the 11th day. In 78% of patients, mobilization was successful in the first attempt (≥2.0x106/kgBM) among which 86% were MM and 69,4% of lymphomas (p<0.05). The impacts of age, the number of CD34+ cells in the peripheral blood and the duration of the mobilization did not show a significant difference (p>0.05) in relation to the recovery of ANC500_11 and PLT20_13.
Conclusion: Satisfactory CD34+ cellular yield can be provided in the first mobilization attempt in most of the patients with usage of GCS-F, while in the further mobilization attempts plerixafor was used. Also, age, therapeutic response and different therapeutic protocols have no impact on ANC500_11 and PLT20_13.
References
2. Incidencija i mortalitet od raka u Centralnoj Srbiji, Registar za rak u Centralnoj Srbiji ISBN 86-7358-030-7 izveštaj broj 16.
3. Durie BG, Salmon SE. A clinical staging system for multiple myeloma Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer. 1975Sep;36(3):842–54.
4. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011 May12;117(19):5019–32.
5. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 19;127(20):2375–90.
6. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the Committee on Hodgkin’s Disease Staging Classification. Cancer Res. 1971Nov;31(11):1860–1.
7. Möhle R, Bautz F, Rafii S, Moore MA, Brugger W, Kanz L. The chemokine receptor CXCR-4 is expressed on CD34+ hematopoietic progenitors and leukemic cells and mediates transendothelial migration induced by stromal cell-derived factor-1. Blood. 1998Jun 15;91(12):4523–30.
8. Petit I, Szyper-Kravitz M, Nagler A, Lahav M, Peled A, Habler L, et al. G-CSF induces stem cell mobilization by decreasing bone marrow SDF-1 and up-regulating CXCR4. Nat Immunol. 2002Jul;3(7):687–94.
9. Broxmeyer HE, Orschell CM, Clapp DW et al. Rapid mobilization of murine and human hematopoietic stem and progenitor cells with AMD3100, a CXCR4 antagonist. J Exp Med. 2005 Apr18;201(8):1307–18.
10. Hosing C, Saliba RM, Ahlawat S, Körbling M, Kebriaei P, Alousi A, et al. Poor hematopoietic stem cell mobilizers: A single institution study of incidence and risk factors in patients with recurrent or relapsed lymphoma. Am J Hematol. 2009Jun;84(6):335–7.
11. Moreb JS, Salmasinia D, Hsu J, Hou W, Cline C, Rosenau E. Long-Term Outcome after Autologous Stem Cell Transplantation with Adequate Peripheral Blood Stem Cell Mobilization Using Plerixafor and G-CSF in Poor Mobilizer Lymphoma and Myeloma Patients. Adv Hematol. 2011;2011: 517561.
12. Beyer J, Schwella N, Zingsem J, Strohscheer I, Schwaner I, Oettle H, et al. Hematopoietic rescue after high-dose chemotherapy using autologous peripheral-blood progenitor cells or bone marrow: a randomized comparison. J Clin Oncol Off J Am Soc Clin Oncol. 1995 Jun;13(6):1328–35.
13. Kyle RA, Finkelstein S, Elveback LR, Kurland LT. Incidence of monoclonal proteins in a Minnesota community with a cluster of multiple myeloma. Blood. 1972Nov;40(5):719–24.
14. Saleun JP, Vicariot M, Deroff P, Morin JF. Monoclonal gammopathies in the adult population of Finistère, France.J Clin Pathol. 1982Jan;35(1):63–8.
15. National Cancer Institute sponsored study of classifications of non-Hodgkin’s lymphomas: summary and description of a working formulation for clinical usage. The Non-Hodgkin’s Lymphoma Pathologic Classification Project. Cancer. 1982 May15;49(10):2112–35.
16. Yoon DH, Sohn BS, Jang G, Kim EK, Kang BW, Kim C, et al. Higher infused CD34+ hematopoietic stem cell dose correlates with earlier lymphocyte recovery and better clinical outcome after autologous stem cell transplantation in non-Hodgkin’s lymphoma. Transfusion (Paris). 2009Sep;49(9):1890–900.
17. Bittencourt H, Rocha V, Chevret S, Socié G, Espérou H, Devergie A, et al. Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA- identical sibling bone marrow transplantation. Blood. 2002 Apr15;99(8):2726–33.
18. Yüksel MK, Tekgündüz E, Sönmez C, Topcuoglu P, Yurtcu A, Demiriz I, et al. A feasible shortcut for the mobilization outcome: Steady state CD34 positive hematopoietic stem cells. Transfus Apher Sci Off J World Apher Assoc Off J Eur Soc Haemapheresis. 2012 Aug;47(1):67–7