Prolonged Lenalidomide Induction Does Not Significantly Impair Stem Cell Collection in Multiple Myeloma Patients Mobilized With Cyclophosphamide or Plerixafor: A Report From The Covid Era

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 22; no. 8; pp. e716 - e729
• Main Authors: Rybinski, Brad, Rapoport, Aaron P, Badros, Ashraf Z., Hardy, Nancy, Kocoglu, Mehmet
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2022
• Subjects: Apheresis multiple myeloma; Apheresis time multiple myeloma; Autologous stem cell transplant; Benzylamines - therapeutic use; COVID-19; Cyclams - therapeutic use; Cyclophosphamide - therapeutic use; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation; Heterocyclic Compounds - pharmacology; Heterocyclic Compounds - therapeutic use; Humans; Lenalidomide - therapeutic use; Lenalidomide multiple myeloma; Multiple Myeloma - drug therapy; Original; Pandemics; Retrospective Studies; Stem cell harvest; Transplantation, Autologous; Autologous stem cell transplant; Lenalidomide multiple myeloma; Apheresis time multiple myeloma; Stem cell harvest; Apheresis multiple myeloma
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2022.03.013

Induction therapy for multiple myeloma is traditionally capped at 6 cycles of lenalidomide due to concerns that longer treatment compromises the ability to collect sufficient stem cells for autologous stem cell transplantation (ASCT). However, during the COVID-19 pandemic, many of our patients received prolonged lenalidomide induction due to concerns about proceeding to ASCT. We investigated whether prolonged induction with lenalidomide affects the efficacy of stem cell collection among patients mobilized with cyclophosphamide and/or plerixafor. This single center, retrospective study included patients who were treated with lenalidomide induction regimens, received mobilization with cyclophosphamide or plerixafor, and underwent apheresis in preparation for ASCT. 94 patients were included, 40 of whom received prolonged induction with >6 cycles of lenalidomide containing regimen. Patients who received prolonged induction were more likely to require >1 day of apheresis (38% vs. 15%; OR 3.45; P = .0154), and there was a significant correlation between the duration of lenalidomide treatment and the apheresis time required to collect sufficient cells for transplant (R2 = 0.06423, P = .0148). However, there was no significant difference between patients who received prolonged induction and those who did not with respect to CD34+ stem cell yields at completion of apheresis (9.99 vs. 10.46 cells/Kg, P = .5513) or on the first day of collection (8.29 vs. 9.59 cells/Kg, P = .1788). Among patients treated with >6 cycles of lenalidomide, mobilization augmented with cyclophosphamide and/or plerixafor will likely facilitate sufficient stem cell harvest to permit ASCT. We investigated whether prolonged lenalidomide treatment impairs stem cell collection among patients with multiple myeloma mobilized with plerixafor or cyclophosphamide. There was no correlation between the duration of lenalidomide therapy and the number of stem cells collected, suggesting that prolonged treatment with lenalidomide is not a significant barrier to stem cell collection in the context of modern mobilization regimens.