Autologous Peripheral Blood Stem Cell Mobilisation Techniques, Stem Cell Yields and Practice Variation-By-Country in Patients with Myeloma Undergoing First Autologous Stem Cell Transplants in EBMT Centres between 2012 and 2021
Blood, vol. 140, pp. 10434–10436
Abstract
The techniques employed to mobilise autologous peripheral blood stem cells in patients with myeloma have evolved over time and vary between countries. The most common methods are (1) Cyclophosphamide and Granulocyte - Colony Stimulating Factor (G-CSF) (Cyclophosphamide), (2) G-CSF only, (3) G-CSF and Plerixafor, and (4) Other. In general, chemotherapy, usually Cyclophosphamide, is used in Europe and single agent G-CSF in North America. We performed a retrospective analysis of the EBMT database to analyse stem cell mobilisation techniques in European patients undergoing a first ASCT for myeloma over the last decade. This data was available on a select cohort of patients for whom Med B form data had been submitted. A total of 76,923 patients received a first autologous stem cell transplant for myeloma in 501 EBMT-affiliated centres between 2012 and 2021. Detailed Stem cell mobilization data including CD34 results were available on 4,710 (M 58%: F 42%) patients from 87 centers. The Median (IQR) age was 61.3 (54.7-66.1) years. MM subtypes were IgG, IgA, Light Chain and Other in 56.6%, 19.2%, 20.8% and 3.4%, respectively. The stage at first transplant was CR, VGPR/PR, SD/MR, and Rel/Prog in 17.5%, 78.4%, 2.8% and 1.3%, respectively. The frequency of use of each of the stem cell mobilization techniques were as follows: Cyclophosphamide (n=3,017, 67.1%), G-CSF only (n=1,207, 26.9%), G-CSF + Plerixafor (n=222, 4.9%) and Other (47, 1.0%). Peripheral blood stem cells were the sole stem cell source in 4,705 (99.9%) of the transplants. The comparative median annual CD34 yields (x10e6/kg) are shown below and reveal that the yields following Cyclophosphamide-based mobilization were consistently higher (6.14-7.8) than those following either G-CSF (4.46-6.1) or G-CSF and Plerixafor (2.5-5.6). When analyzed in aggregate, the median (IQR) stem cell yields (x10e6/kg) following Cyclophosphamide, G-CSF, G-CSF and Plerixafor, and Other were 7.32 (4.9-10.14), 5.25 (3.88-7.38), 4.94 (3.42-6.85) and 4.9 (3.82-7.54), respectively. When analysed by MM subtype, there was no significant difference in yield between the IgG, IgA, Light Chain and Other categories (p=0.523). We next analyzed the median annual CD34 yields (x10e6/kg) by induction regimen (no. of pts): CTD (Cyclophosphamide, Thalidomide, Dexamethasone) (n=712) 7.56, Other (n=623) 5.86, PAD (Bortezomib, Adriamycin, Dexamethasone) (n=256) 5.8, VAD (Vincristine, Adriamycin, Dexamethasone) (n=172) 5.03, VCD (Bortezomib, Cyclophosphamide, Dexamethasone) (n=1,735) 6.21, VD (Bortezomib, Dexamethasone) (n=603) 5.97, VRD (Bortezomib, Lenalidomide, Dexamethasone) (n=811) 5.42 and VTD (Bortezomib, Thalidomide, Dexamethasone) (n=3,192) 7.12 (p<0.001), the highest yields being collected following CTD and VTD (<0.001). We finally examined mobilization trends in the seven largest countries in the dataset (France, Germany, Italy, the Netherlands, Spain, Turkey, and the United Kingdom) over time. Data was available for between 9.6% and 22.8% of patients in 6 of the 7 countries; however, it was only available in 2.9% of patients from Germany. Within these clear limitations, there were wide national variations in clinical practice both over time and between countries, as shown below. Over the last decade, two-thirds of patients in EMBT centres underwent autologous stem cell collection following Cyclophosphamide and G-CSF, one quarter following single agent G-CSF and 5% following G-CSF and Plerixafor. As reported previously, yields were consistently higher following chemotherapy-based mobilization. However, we have no data on associated morbidity such as the incidence of infection, the need for hospital admission or costs. As regards the effect of prior induction regimens, the highest yields were seen in patients who had received either CTD or VTD induction, possibly reflecting less stem cell toxicity due to chemotherapy and/or deeper remissions following these regimens. Finally, limited data on trends in practice appears to show considerable variation between countries combined with significant changes in some countries over the last decade. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
Authors 25
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Trinity College Dublin · St. James's Hospital
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1Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
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European Society for Blood and Marrow Transplantation
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2EBMT Statistical Unit, Leiden, Netherlands
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European Society for Blood and Marrow Transplantation
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3EBMT Leiden Study Unit, Leiden, Netherlands
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Sheffield Teaching Hospitals NHS Foundation Trust
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4Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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5Centre Hospitalier Universitaire De Dijon, Hôpital Du Bocage, Dijon, France
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Maastricht University Medical Centre
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6Dept. Internal Med.Hematology /Oncology, University Hospital Maastricht, Maastricht, Netherlands
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Vilnius University · Vilnius University Hospital Santariskiu Klinikos
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7Department of Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
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University of Rome Tor Vergata
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8Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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9Addenbrooke's Hospital, Cambridge, GBR
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10Oncology Department, Hematology and Bone Marrow Transplant Unit, Ospedale La Maddalena, Palermo, Italy
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Centre Hospitalier Universitaire de Grenoble · Université Grenoble Alpes
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11Service d'Hématologie, CHU Grenoble Alpes - Université Grenoble Alpes, Grenoble, France
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12Leicester Royal Infirmary, Leicester, United Kingdom
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13Hague Teaching Hospital, The Hague, Netherlands
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14Alberts Cellular Therapy, Pretoria East Hospital, Pretoria, South Africa
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Universitair Ziekenhuis Leuven · KU Leuven
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15University Hospital Gasthuisberg, Leuven, Belgium
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Azienda Ospedaliera San Gerardo
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16Ospedale San Gerardo, Monza, Italy
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Affiliation as printed
17Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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18Umea University Hospital, Umeå, Sweden
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19FOSCAL-UNAB, Floridablanca, Colombia
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Medical University of Warsaw · Central Clinical Hospital
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20Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland
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21University College London Hospitals NHS Trust, London, United Kingdom
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22Ankara University, Ankara, Turkey
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Heidelberg University · University Hospital Heidelberg
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23Department of Internal Medicine V, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
24Medizinische Klinik V and Amyloidosis Center, Universitätsklinikum Heidelberg, Heidelberg, Germany
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University College London Hospitals NHS Foundation Trust
Affiliation as printed
25Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Inserm · Université de Lille · Centre Hospitalier Universitaire de Lille · Lille Inflammation Research International Center · Institute for Translational Research in Inflammation
Affiliation as printed
26Centre Hospitalier Universitaire de Lille LIRIC, INSERM U1286, Université de Lille, LILLE, France
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