J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://www.thejh.org

Original Article

Volume 13, Number 3, June 2024, pages 79-85

Steady-State Versus Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma: A Single-Center Study to Analyze Efficacy and Safety

Figure 1. The effect of LEN, Dara and mobilization strategy on the amount of bone marrow stem cells collected (a-c), the number of days of apheresis (d-f) and the length of hospital stay (g-i). LEN: lenalidomide; Dara: daratumumab; G-CSF: granulocyte colony-stimulating factor.

**Table 1.** Patient Characteristics and Comparison of Different Stem Cell Mobilization Approaches
Characteristics	All patients (n = 210)	Chemotherapy + G-CSF group (n = 106)	Solo G-CSF group (n = 104)	P-value
G-CSF: granulocyte colony-stimulating factor; Ig: immunoglobulin; LCD: light chain disease; NS: non-secretory; R-ISS: revised International Scoring System; FISH: fluorescence in situ hybridization; VTD: bortezomib, thalidomide and dexamethasone; VRD: bortezomib, lenalidomide and dexamethasone; VCD: bortezomib, cyclophosphamide and dexamethasone; dg.: diagnosis; CR: complete response; VGPR: very good partial response; PR: partial response; SD: stable disease; AHSCT: autologous hematopoietic stem cell transplantation; ns: not significant.
Age, median (range)	61 (32 - 75)	59 (38 - 75)	63 (32 - 75)	ns
Sex, male/female (%)	107/103 (51/49)	55/51 (52/48)	52/52 (50/50)	ns
M-protein type, n (%)				ns
IgG	128 (61)	60 (58)	68 (65)
IgA	39 (19)	19 (18)	20 (19)
IgM	1 (0.5)	1 (1)	0
IgD	2 (1)	1 (1)	1 (1)
LCD	37 (18)	22 (21)	15 (15)
NS	1 (0.5)	1 (1)	0
R-ISS, n (%)				ns
I	34 (16)	17 (16)	17 (16)
II	58 (27)	27 (25)	31 (30)
III	77 (37)	38 (36)	39 (38)
n/a	41 (20)	24 (23)	17 (16)
FISH risk, n (%)				ns
Standard	69 (33)	34 (32)	37 (36)
High	92 (44)	46 (43)	47 (45)
n/a	49 (23)	26 (25)	20 (19)
Previous lines of therapy, median (range)	1 (1 - 6)	1 (1 - 6)	1 (1 - 3)	ns
Number of previous lines, n (%)				ns
1	152 (73)	73 (69)	83 (80)
2	45 (22)	27 (25)	18 (17)
≥ 3	9 (5)	6 (6)	3 (3)
First-line therapy				ns
VTD	119 (57)	63 (59)	56 (54)
VRD	37 (18)	14 (13)	24 (23)
VCD	42 (20)	23 (22)	19 (18)
Other	12 (5)	6 (6)	5 (5)
Previous exposure of, n (%)				ns
Lenalidomid	71 (34)	30 (28)	41 (39)
Daratumumab	18 (9)	7 (7)	11 (11)
Venetoclax	10 (5)	5 (5)	5 (5)
Time from dg. to mobilization, months, median (range)	5.5 (2.6 - 107.2)	5.5 (0.6 - 107.2)	5.4 (2.6 - 23.2)	ns
Disease status before mobilization, n (%)				ns
CR	51 (24)	24 (23)	27 (26)
VGPR	91 (43)	45 (42)	46 (44)
PR	66 (32)	35 (33)	31 (30)
SD	2 (1)	2 (2)	0
Karnofsky status before AHSCT, %, median (range)	90 (60 - 100)	90 (60 - 100)	90 (70 - 100)	ns
Mobilization failure, n (%)	5 (2)	3 (3)	11 (11)	0.024
Plerixafor usage, n (%)	61 (29)	14 (13)	47 (45)	< 0.001
Days of apheresis, median (range)	2 (0 - 4)	2 (0 - 4)	2 (1 - 4)	ns
Total CD34⁺ stem cells, n, × 10⁶, median (range)	7.8 (0.5 - 29)	8.9 (1.8 - 29)	6.8 (0.5 - 21)	< 0.001
Infectious complications, n (%)	33 (16)	29 (27)	4 (4)	< 0.001
Hospital stay, days, median (range)	11 (2 - 27)	14 (9 - 27)	6 (2 - 11)	< 0.001

Table 1. Patient Characteristics and Comparison of Different Stem Cell Mobilization Approaches

Characteristics

All patients (n = 210)

Chemotherapy + G-CSF group (n = 106)

Solo G-CSF group (n = 104)

P-value

G-CSF: granulocyte colony-stimulating factor; Ig: immunoglobulin; LCD: light chain disease; NS: non-secretory; R-ISS: revised International Scoring System; FISH: fluorescence in situ hybridization; VTD: bortezomib, thalidomide and dexamethasone; VRD: bortezomib, lenalidomide and dexamethasone; VCD: bortezomib, cyclophosphamide and dexamethasone; dg.: diagnosis; CR: complete response; VGPR: very good partial response; PR: partial response; SD: stable disease; AHSCT: autologous hematopoietic stem cell transplantation; ns: not significant.

Age, median (range)

61 (32 - 75)

59 (38 - 75)

63 (32 - 75)

Sex, male/female (%)

107/103 (51/49)

55/51 (52/48)

52/52 (50/50)

M-protein type, n (%)

IgG

128 (61)

60 (58)

68 (65)

IgA

39 (19)

19 (18)

20 (19)

IgM

1 (0.5)

1 (1)

IgD

2 (1)

1 (1)

LCD

37 (18)

22 (21)

15 (15)

1 (0.5)

1 (1)

R-ISS, n (%)

34 (16)

17 (16)

58 (27)

27 (25)

31 (30)

III

77 (37)

38 (36)

39 (38)

n/a

41 (20)

24 (23)

17 (16)

FISH risk, n (%)

Standard

69 (33)

34 (32)

37 (36)

High

92 (44)

46 (43)

47 (45)

n/a

49 (23)

26 (25)

20 (19)

Previous lines of therapy, median (range)

1 (1 - 6)

1 (1 - 3)

Number of previous lines, n (%)

152 (73)

73 (69)

83 (80)

45 (22)

27 (25)

18 (17)

≥ 3

9 (5)

6 (6)

3 (3)

First-line therapy

VTD

119 (57)

63 (59)

56 (54)

VRD

37 (18)

14 (13)

24 (23)

VCD

42 (20)

23 (22)

19 (18)

Other

12 (5)

6 (6)

5 (5)

Previous exposure of, n (%)

Lenalidomid

71 (34)

30 (28)

41 (39)

Daratumumab

18 (9)

7 (7)

11 (11)

Venetoclax

10 (5)

5 (5)

Time from dg. to mobilization, months, median (range)

5.5 (2.6 - 107.2)

5.5 (0.6 - 107.2)

5.4 (2.6 - 23.2)

Disease status before mobilization, n (%)

51 (24)

24 (23)

27 (26)

VGPR

91 (43)

45 (42)

46 (44)

66 (32)

35 (33)

31 (30)

2 (1)

2 (2)

Karnofsky status before AHSCT, %, median (range)

90 (60 - 100)

90 (70 - 100)

Mobilization failure, n (%)

5 (2)

3 (3)

11 (11)

0.024

Plerixafor usage, n (%)

61 (29)

14 (13)

47 (45)

< 0.001

Days of apheresis, median (range)

2 (0 - 4)

2 (1 - 4)

Total CD34⁺ stem cells, n, × 10⁶, median (range)

7.8 (0.5 - 29)

8.9 (1.8 - 29)

6.8 (0.5 - 21)

< 0.001

Infectious complications, n (%)

33 (16)

29 (27)

4 (4)

< 0.001

Hospital stay, days, median (range)

11 (2 - 27)

14 (9 - 27)

6 (2 - 11)

< 0.001

**Table 2.** Univariate and Multivariable Logistic Regression Analyses of Disease Parameters, Associated With Infectious Complications, Plerixafor Use and Mobilization Failure
Variable	Univariate analysis	Multivariable analysis
CI: confidence interval; FISH: fluorescence in situ hybridization; OR: odds ratio; VGPR: very good partial response.
Infectious complications
Male sex	1.372	0.648 - 2.907	0.407
High-risk FISH	1.541	0.642 - 3.696	0.330
> 1 lines of therapy	2.156	0.988 - 4.707	0.050
Lenalidomide exposure	0.383	0.150 - 0.976	0.039	1.677	0.539 - 5.219	0.372
Daratumumab exposure	0.294	0.038 - 2.290	0.216
Below VGPR disease status	1.235	0.568 - 2.685	0.594
Chemomobilization	9.416	3.176 - 27.915	< 0.001	7.392	2.366 - 23.090	0.001
Plerixafor use
Male sex	1.582	0.866 - 2.890	0.135
High-risk FISH	1.061	0.546 - 2.062	0.862
> 1 lines of therapy	1.473	0.761 - 2.854	0.249
Lenalidomide exposure	2.309	1.247 - 4.276	0.007	0.673	0.294 - 1.542	0.349
Daratumumab exposure	10.798	3.389 - 34.406	< 0.001	0.077	0.014 - 0.431	0.003
Below VGPR disease status	1.548	0.830 - 2.885	0.168
Chemomobilization	0.185	0.093 - 0.365	< 0.001	0.176	0.076 - 0.407	< 0.001
Mobilization failure
Male sex	1.953	0.166 - 1.583	0.278
High-risk FISH	1.154	0.235 - 3.191	1.000
> 1 lines of therapy	1.168	0.257 - 2.852	0.759
Lenalidomide exposure	2.817	0.937 - 8.475	0.056
Daratumumab exposure	1.876	0.386 - 9.091	0.429
Below VGPR disease status	1.212	0.366 - 4.014	0.753
Chemomobilization	0.246	0.067 - 0.910	0.024	4.55	0.850 - 24.357	0.077

Table 2. Univariate and Multivariable Logistic Regression Analyses of Disease Parameters, Associated With Infectious Complications, Plerixafor Use and Mobilization Failure

Variable

Univariate analysis

Multivariable analysis

95% CI

P-value

95% CI

P-value

CI: confidence interval; FISH: fluorescence in situ hybridization; OR: odds ratio; VGPR: very good partial response.

Infectious complications

Male sex

1.372

0.648 - 2.907

0.407

High-risk FISH

1.541

0.642 - 3.696

0.330

> 1 lines of therapy

2.156

0.988 - 4.707

0.050

Lenalidomide exposure

0.383

0.150 - 0.976

0.039

1.677

0.539 - 5.219

0.372

Daratumumab exposure

0.294

0.038 - 2.290

0.216

Below VGPR disease status

1.235

0.568 - 2.685

0.594

Chemomobilization

9.416

3.176 - 27.915

< 0.001

7.392

2.366 - 23.090

0.001

Plerixafor use

Male sex

1.582

0.866 - 2.890

0.135

High-risk FISH

1.061

0.546 - 2.062

0.862

> 1 lines of therapy

1.473

0.761 - 2.854

0.249

Lenalidomide exposure

2.309

1.247 - 4.276

0.007

0.673

0.294 - 1.542

0.349

Daratumumab exposure

10.798

3.389 - 34.406

< 0.001

0.077

0.014 - 0.431

0.003

Below VGPR disease status

1.548

0.830 - 2.885

0.168

Chemomobilization

0.185

0.093 - 0.365

< 0.001

0.176

0.076 - 0.407

< 0.001

Mobilization failure

Male sex

1.953

0.166 - 1.583

0.278

High-risk FISH

1.154

0.235 - 3.191

1.000

> 1 lines of therapy

1.168

0.257 - 2.852

0.759

Lenalidomide exposure

2.817

0.937 - 8.475

0.056

Daratumumab exposure

1.876

0.386 - 9.091

0.429

Below VGPR disease status

1.212

0.366 - 4.014

0.753

Chemomobilization

0.246

0.067 - 0.910

0.024

4.55

0.850 - 24.357

0.077