Abstract
Lenalidomide is an agent that has shown great activity in patients with multiple myeloma (MM). However, studies have suggested that this drug negatively affects subsequent stem cell collection. To investigate whether lenalidomide impairs stem cell mobilization and collection, we reviewed data for patients with MM who underwent mobilization with filgrastim. Predictors of mobilization failure were evaluated using logistic regression analysis. In 26 (9%) of 302 myeloma patients, stem cell mobilization failed. Mobilization failed in 25% of patients who had previously received lenalidomide, compared with 4% of patients who had not received lenalidomide (P < .001). In a multivariate analysis, prior lenalidomide use (odds ratio: 5.9; 95% confidence interval [CI]: 2.4-14.3) and mobilization more than 1 year after diagnosis (odds ratio: 4.6; 95% CI: 1.9-11.1) were significantly associated with failed mobilization. Twenty-one of 26 patients in whom mobilization with filgrastim failed underwent remobilization with chemotherapy and filgrastim; in 18 (86%) of these 21 patients, stem cells were successfully mobilized and collected. In patients with multiple myeloma, prior lenalidomide therapy is associated with failure of stem cell mobilization with filgrastim. Remobilization with chemotherapy and filgrastim is usually successful in these patients.
MeSH terms
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Adult
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Aged
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Angiogenesis Inhibitors / administration & dosage
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Angiogenesis Inhibitors / adverse effects
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Angiogenesis Inhibitors / therapeutic use
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Antineoplastic Agents / administration & dosage
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Antineoplastic Agents / adverse effects*
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Antineoplastic Agents / pharmacology
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Antineoplastic Agents / therapeutic use
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Antineoplastic Combined Chemotherapy Protocols / administration & dosage
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Benzylamines
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Bone Marrow / drug effects*
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Combined Modality Therapy
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Cyclams
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / pharmacology
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Dexamethasone / administration & dosage
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Doxorubicin / administration & dosage
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Etoposide / administration & dosage
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Etoposide / pharmacology
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Female
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Filgrastim
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Granulocyte Colony-Stimulating Factor / administration & dosage
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Granulocyte Colony-Stimulating Factor / antagonists & inhibitors*
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Granulocyte Colony-Stimulating Factor / pharmacology
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Hematopoietic Stem Cell Mobilization / methods*
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Heterocyclic Compounds / administration & dosage
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Heterocyclic Compounds / pharmacology
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Humans
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Ifosfamide / administration & dosage
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Ifosfamide / pharmacology
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Lenalidomide
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Leukapheresis
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Male
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Middle Aged
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Multiple Myeloma / blood*
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Multiple Myeloma / drug therapy
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Multiple Myeloma / radiotherapy
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Multiple Myeloma / surgery
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Peripheral Blood Stem Cell Transplantation*
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Recombinant Proteins
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Retrospective Studies
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Risk Factors
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Thalidomide / administration & dosage
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Thalidomide / adverse effects
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Thalidomide / analogs & derivatives*
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Thalidomide / therapeutic use
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Transplantation, Autologous
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Treatment Failure
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Vincristine / administration & dosage
Substances
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Angiogenesis Inhibitors
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Antineoplastic Agents
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Benzylamines
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Cyclams
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Heterocyclic Compounds
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Recombinant Proteins
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Granulocyte Colony-Stimulating Factor
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Thalidomide
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Vincristine
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Etoposide
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Dexamethasone
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Doxorubicin
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Cyclophosphamide
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Lenalidomide
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Filgrastim
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plerixafor
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Ifosfamide