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Peripheral blood stem cell transplants for multiple myeloma: identification
of favorable variables for rapid engraftment in 225 patients
G Tricot, S Jagannath, D Vesole, J Nelson, S Tindle, L Miller, B Cheson, J Crowley and B Barlogie
Division of Hematology/Oncology, University of Arkansas for Medical
Sciences, Little Rock 72205.
Transfusion of autologous peripheral blood stem cells (PBSCs) of good
quality ensures fast hematopoietic engraftment after myeloablative therapy
with a decrease in procedure-related morbidity and mortality. We have
analyzed variables influencing the kinetics of engraftment, and therefore
reflecting the quality of PBSC collections, in 225 patients with newly
diagnosed or refractory multiple myeloma (MM) who received an
autotransplant in support of high dose melphalan (200 mg/m2); 132 of these
patients also completed a second transplant. All PBSCs were collected
before the first transplant after high-dose cyclophosphamide (6 g/m2) and
hematopoietic growth factors, mainly granulocyte- macrophage
colony-stimulating factor. PBSCs were administered either alone (91
patients) or with bone marrow (134 patients). A highly significant
correlation was observed between the number of CD34+ cells per kilogram
infused and prompt recovery of both granulocytes (P = .0001) and platelets
(P = .0001). After correction for the proportion of patients with > or =
2 x 10(6)/kg CD34 PBSCs infused and with < or = 12 months of prior
therapy, no difference in engraftment kinetics was seen between patients
receiving PBSCs only and those also receiving bone marrow. Exposure to
chemotherapy, even to < or = 6 months of alkylating agents,
significantly delayed hematopoietic recovery posttransplantation. The
threshold dose of CD34 cells necessary for prompt engraftment was > or =
2.0 x 10(6)/kg for patients with < or = 24 months of chemotherapy before
the first transplant, whereas greater than 5 x 10(6)/kg CD34 cells were
required to assure rapid recovery also in those with longer exposure. Such
quantities, easily collected in the large majority of patients with shorter
exposure (91%), were obtained in only 28% of patients with more than 24
months of prior chemotherapy. Rapid platelet recovery within a narrow range
of time (before day 14) was almost invariably seen (94%) when greater than
5 x 10(6)/kg CD34 cells were infused, irrespective of the duration of prior
therapy, whereas the range widened progressively when less CD34 cells were
infused. In the absence of CD34 measurements, fast recovery of platelets to
greater than 50 x 10(9)/L within 14 days after high-dose cyclophosphamide
and < or = 12 months of prior chemotherapy were the best predictors of
early engraftment. Prudent use of stem cell-damaging agents, such as
melphalan and nitrosoureas, is recommended in MM patients who might be
candidates for autotransplantation. Alternatively, PBSCs should be
collected early after diagnosis.
Volume 85,
Issue 2,
pp. 588-596,
01/15/1995
Copyright © 1995 by The American Society of Hematology
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