Single-dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma

Yong Park, Dae Sik Kim, Min Ji Jeon, Byung Hyun Lee, Eun Sang Yu, Ka Won Kang, Se Ryeon Lee, Hwa Jung Sung, Myung-Hyun Nam, Soo-Young Yoon, Chul Won Choi, Eun Suk Kang, Duck Cho, Kihyun Kim, Byung Soo Kim, Dae Won Kim, Seok Jin Kim

Research output: Contribution to journalArticle

Abstract

Background: Single-dose etoposide was used an outpatient-based protocol for mobilization in patients with multiple myeloma (MM) for autologous stem cell transplantation (ASCT). Thus, we retrospectively analyzed the efficacy and safety of our one-day protocol in comparison with that of previous methods. Methods: We retrospectively analyzed 168 patients with MM who underwent peripheral blood stem cell collection for upfront ASCT between 2008 and 2018. The mobilization protocols included G-CSF alone (G-mobilization), one-day 375 mg/m2 of etoposide (E375), two-days of 375 mg/m2 of etoposide (E750), or one-day high-dose (3.5 g/m2) cyclophosphamide (HD CY). For comparison of efficacy of each protocol, collected CD34+ cells over 4 × 106/kg and under 2 × 106/kg were defined as “adequate harvest” and “harvest failure,” respectively. Results: The median number of collected CD34+ cells was 5.58 × 106/kg in patients receiving single-dose etoposide, and the percentage of uncomplicated optimal harvest of E375 (65.6%, 21/32) was significantly higher than that of E750 (41.9%, 13/31) and HD CY (31.3%, 15/48). The E375 showed the highest rate of adequate harvest (96.9%, 31/32) compared to that of E750 (87.1%), HD CY (75.0%), and G-mobilization (59.6%). Most E375 patients achieved adequate harvest without complication (29/32, 90.6%), the CD34+ cell collection yield on apheresis days one and two of E375 was not significantly different from that of E750, and no harvest failures occurred for E375. Neutrophil and platelet engraftments were significantly faster in E375 than other groups (P <.001). Conclusions: The use of single-dose etoposide could be an effective and safe method for mobilization in patients with MM.

Original languageEnglish
JournalJournal of Clinical Apheresis
DOIs
Publication statusPublished - 2019 Jan 1

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Hematopoietic Stem Cell Mobilization
Etoposide
Multiple Myeloma
Stem Cell Transplantation
Blood Component Removal
Granulocyte Colony-Stimulating Factor
Cyclophosphamide
Neutrophils
Outpatients
Blood Platelets
Safety

Keywords

  • autologous stem cell transplantation
  • etoposide
  • mobilization
  • multiple myeloma

ASJC Scopus subject areas

  • Hematology

Cite this

Single-dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma. / Park, Yong; Kim, Dae Sik; Jeon, Min Ji; Lee, Byung Hyun; Yu, Eun Sang; Kang, Ka Won; Lee, Se Ryeon; Sung, Hwa Jung; Nam, Myung-Hyun; Yoon, Soo-Young; Choi, Chul Won; Kang, Eun Suk; Cho, Duck; Kim, Kihyun; Kim, Byung Soo; Kim, Dae Won; Kim, Seok Jin.

In: Journal of Clinical Apheresis, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Single-dose etoposide was used an outpatient-based protocol for mobilization in patients with multiple myeloma (MM) for autologous stem cell transplantation (ASCT). Thus, we retrospectively analyzed the efficacy and safety of our one-day protocol in comparison with that of previous methods. Methods: We retrospectively analyzed 168 patients with MM who underwent peripheral blood stem cell collection for upfront ASCT between 2008 and 2018. The mobilization protocols included G-CSF alone (G-mobilization), one-day 375 mg/m2 of etoposide (E375), two-days of 375 mg/m2 of etoposide (E750), or one-day high-dose (3.5 g/m2) cyclophosphamide (HD CY). For comparison of efficacy of each protocol, collected CD34+ cells over 4 × 106/kg and under 2 × 106/kg were defined as “adequate harvest” and “harvest failure,” respectively. Results: The median number of collected CD34+ cells was 5.58 × 106/kg in patients receiving single-dose etoposide, and the percentage of uncomplicated optimal harvest of E375 (65.6{\%}, 21/32) was significantly higher than that of E750 (41.9{\%}, 13/31) and HD CY (31.3{\%}, 15/48). The E375 showed the highest rate of adequate harvest (96.9{\%}, 31/32) compared to that of E750 (87.1{\%}), HD CY (75.0{\%}), and G-mobilization (59.6{\%}). Most E375 patients achieved adequate harvest without complication (29/32, 90.6{\%}), the CD34+ cell collection yield on apheresis days one and two of E375 was not significantly different from that of E750, and no harvest failures occurred for E375. Neutrophil and platelet engraftments were significantly faster in E375 than other groups (P <.001). Conclusions: The use of single-dose etoposide could be an effective and safe method for mobilization in patients with MM.",
keywords = "autologous stem cell transplantation, etoposide, mobilization, multiple myeloma",
author = "Yong Park and Kim, {Dae Sik} and Jeon, {Min Ji} and Lee, {Byung Hyun} and Yu, {Eun Sang} and Kang, {Ka Won} and Lee, {Se Ryeon} and Sung, {Hwa Jung} and Myung-Hyun Nam and Soo-Young Yoon and Choi, {Chul Won} and Kang, {Eun Suk} and Duck Cho and Kihyun Kim and Kim, {Byung Soo} and Kim, {Dae Won} and Kim, {Seok Jin}",
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T1 - Single-dose etoposide is an effective and safe protocol for stem cell mobilization in patients with multiple myeloma

AU - Park, Yong

AU - Kim, Dae Sik

AU - Jeon, Min Ji

AU - Lee, Byung Hyun

AU - Yu, Eun Sang

AU - Kang, Ka Won

AU - Lee, Se Ryeon

AU - Sung, Hwa Jung

AU - Nam, Myung-Hyun

AU - Yoon, Soo-Young

AU - Choi, Chul Won

AU - Kang, Eun Suk

AU - Cho, Duck

AU - Kim, Kihyun

AU - Kim, Byung Soo

AU - Kim, Dae Won

AU - Kim, Seok Jin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Single-dose etoposide was used an outpatient-based protocol for mobilization in patients with multiple myeloma (MM) for autologous stem cell transplantation (ASCT). Thus, we retrospectively analyzed the efficacy and safety of our one-day protocol in comparison with that of previous methods. Methods: We retrospectively analyzed 168 patients with MM who underwent peripheral blood stem cell collection for upfront ASCT between 2008 and 2018. The mobilization protocols included G-CSF alone (G-mobilization), one-day 375 mg/m2 of etoposide (E375), two-days of 375 mg/m2 of etoposide (E750), or one-day high-dose (3.5 g/m2) cyclophosphamide (HD CY). For comparison of efficacy of each protocol, collected CD34+ cells over 4 × 106/kg and under 2 × 106/kg were defined as “adequate harvest” and “harvest failure,” respectively. Results: The median number of collected CD34+ cells was 5.58 × 106/kg in patients receiving single-dose etoposide, and the percentage of uncomplicated optimal harvest of E375 (65.6%, 21/32) was significantly higher than that of E750 (41.9%, 13/31) and HD CY (31.3%, 15/48). The E375 showed the highest rate of adequate harvest (96.9%, 31/32) compared to that of E750 (87.1%), HD CY (75.0%), and G-mobilization (59.6%). Most E375 patients achieved adequate harvest without complication (29/32, 90.6%), the CD34+ cell collection yield on apheresis days one and two of E375 was not significantly different from that of E750, and no harvest failures occurred for E375. Neutrophil and platelet engraftments were significantly faster in E375 than other groups (P <.001). Conclusions: The use of single-dose etoposide could be an effective and safe method for mobilization in patients with MM.

AB - Background: Single-dose etoposide was used an outpatient-based protocol for mobilization in patients with multiple myeloma (MM) for autologous stem cell transplantation (ASCT). Thus, we retrospectively analyzed the efficacy and safety of our one-day protocol in comparison with that of previous methods. Methods: We retrospectively analyzed 168 patients with MM who underwent peripheral blood stem cell collection for upfront ASCT between 2008 and 2018. The mobilization protocols included G-CSF alone (G-mobilization), one-day 375 mg/m2 of etoposide (E375), two-days of 375 mg/m2 of etoposide (E750), or one-day high-dose (3.5 g/m2) cyclophosphamide (HD CY). For comparison of efficacy of each protocol, collected CD34+ cells over 4 × 106/kg and under 2 × 106/kg were defined as “adequate harvest” and “harvest failure,” respectively. Results: The median number of collected CD34+ cells was 5.58 × 106/kg in patients receiving single-dose etoposide, and the percentage of uncomplicated optimal harvest of E375 (65.6%, 21/32) was significantly higher than that of E750 (41.9%, 13/31) and HD CY (31.3%, 15/48). The E375 showed the highest rate of adequate harvest (96.9%, 31/32) compared to that of E750 (87.1%), HD CY (75.0%), and G-mobilization (59.6%). Most E375 patients achieved adequate harvest without complication (29/32, 90.6%), the CD34+ cell collection yield on apheresis days one and two of E375 was not significantly different from that of E750, and no harvest failures occurred for E375. Neutrophil and platelet engraftments were significantly faster in E375 than other groups (P <.001). Conclusions: The use of single-dose etoposide could be an effective and safe method for mobilization in patients with MM.

KW - autologous stem cell transplantation

KW - etoposide

KW - mobilization

KW - multiple myeloma

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