Stem cell mobilization chemotherapy with gemcitabine is effective and safe in myeloma patients with bortezomib-induced neurotoxicity. Issue 5 (3rd May 2016)

• Record Type: Journal Article
• Authors: Mueller, Beatrice U.; Keller, Sandra; Seipel, Katja; Mansouri Taleghani, Behrouz; Rauch, Daniel; Betticher, Daniel; Egger, Thomas; Pabst, Thomas
• Is Part Of: Leukemia & lymphoma. Volume 57:Issue 5(2016:May)
• Page Start: 1122
• Page End: 1129
• Publication Date: 2016-05-03
• Subjects: Autologous -- bortezomib -- gemcitabine -- mobilization -- myeloma -- neurotoxicity -- polyneuropathy -- stem cells -- transplant; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2015.1079315
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: Vinorelbine chemotherapy with granulocyte-colony stimulating factor (G-CSF) stimulation is a widely applied non-myelosuppressive mobilization regimen in Switzerland for myeloma patients, but its neurotoxic potential limits its use in patients with bortezomib-induced polyneuropathy. In this single-center study, we alternatively evaluated safety and effectiveness of gemcitabine chemotherapy with G-CSF for mobilization of autologous stem cells. Between March 2012 and February 2013, all bortezomib-pretreated myeloma patients planned to undergo first-line high-dose melphalan chemotherapy received a single dose of 1250 mg/m 2 gemcitabine, with G-CSF started on day 4. The 24 patients in this study had received a median of four cycles of bortezomib-dexamethason-based induction. Bortezomib-related polyneuropathy was identified in 21 patients (88%) by clinical evaluation and a standardized questionnaire. Administration of gemcitabine mobilization did not induce new or aggravate pre-existing neuropathy. Stem cell mobilization was successful in all 24 patients, with a single day of apheresis being sufficient in 19 patients (78%). The median yield was 9.51 × 10 6 CD34+ cells/kg. Stem collection could be accomplished at day 8 in 67%. Our data suggest that single-dose gemcitabine together with G-CSF is an effective mobilization regimen in myeloma patients and a safe alternative non-myelosuppressive mobilization chemotherapy for myeloma patients with bortezomib-induced polyneuropathy.