The Study Of Etoposide Combined With G-CSF In The Mobilization Of Autologous Peripheral Blood Hematopoietic Stem Cells In Multiple Myeloma

Background and objective:Autologous hematopoietic stem cell transplantation(ASCT)is a significant method for multiple myeloma(MM).Successful mobilization of peripheral blood stem cells(PBSC)is a necessary condition for successful ASCT.PBSC mobilization programs for MM patients are mainly divided into three categories:granulocyte colony stimulating factor(G-CSF)alone,chemotherapy combined with G-CSF,as well as prexafol combined with G-CSF.However,the optimal mobilization scheme is still uncertain.In this study,clinical information of MM patients mobilized in 2domestic centers was retrospectively analyzed to explore the efficacy and safety of etoposide(VP-16)combined with G-CSF in PBSC mobilization of MM patients.Furthermore,the differences between VP-16 combined with pegylated recombinant human granulocyte colony stimulating factor(PEG-rhG-CSF)and VP-16 combined with short-acting G-CSF in efficacy,adverse reactions and hematopoietic reconstruction after transplantation were further compared,hoping to provide a more effective mobilization program for MM patients..Methods:Clinical data of 102 MM patients with PBSC mobilization using VP-16combined with G-CSF were collected from 2 domestic centers from April 2019 to December 2022.The clinical characteristics,collection effect,mobilization related adverse reactions and hematopoietic reconstruction time and other indicators were analyzed.VP-16 combined with PEG-rhG-CSF(PEG-rhG-CSF)and VP-16 combined with short-acting G-CSF(short-acting G-CSF)were compared.The differences between the two groups in the number of collected CD34~+cells,the success rate of collection,the good and good rate of collection,the number of mononuclear cells(MNC),the number of collection times,the mobilization related adverse reactions and the days of hematopoietic reconstruction were analyzed.Results:1.Clinical features of MM patients undergoing peripheral blood stem cell mobilization:The median age of 102 patients at the time of autologous PBSC mobilization was 57 years.The median course of treatment before mobilization was 4cycles,and the median course of treatment before mobilization was 3 cycles.Ninety-nine patients(97.1%)received first-line treatment;Fifty-five patients(53.9%)got a complete response(CR)before mobilization,27 patients(26.5%)got a very good partial response(VGPR),and 20 patients(19.6%)got a partial response(PR).2.Effectiveness and security of mobilization:The median number of collected CD34~+cells was 9.9×10~6/kg.The median number of MNC was 7.7×10~8/kg.The success rate,excellent and good rate,and the proportion of CD34~+cells≥10×10~6/L were 95.1%,79.4%and 50.0%,respectively.The median days from mobilization to stem cell collection was 10.The median number of collection was 1,and the average mobilization cost was 22,162.6 yuan.The main mobility-related adverse reactions were decreased neutrophil count(grade 3-4),decreased platelet count(grade 3-4),febrile neutropenia,pneumonia and bone pain,accounting for 79.4%,44.1%,7.8%,2.9%and 9.8%,respectively.The median time of antibiotic use during mobilization was 4 days and the median platelet transfusion volume was 1 unit.3.Autologous transplantation:A total of 74 patients underwent ASCT.The median days from diagnosis to transplantation was 6,the mean number of CD34~+cells transfused was 5.2×10~6/kg.The median days of neutrophil implantation was 10.5.The median days for platelet implantation was 11.4.Comparison between PEG-rhG-CSF group and short-acting G-CSF group:The number of CD34~+cells collected in PEG-rhG-CSF group was higher than that in short-acting G-CSF group(P=0.003,P=0.089,P=0.046,P<0.001),the success rate of collection,the rate of good and good collection,and the proportion of CD34~+cells≥10×10~6/L.The number of collection times and days of mobilization to stem cell collection in the PEG-rhG-CSF group were less than those in the short-acting G-CSF group(P<0.001,P<0.001).However,the number of MNC collected in PEG-rhG-CSF group was smaller than that in short-acting G-CSF group,and the difference was not statistically significant(P=0.229).The cost of PEG-rhG-CSF group was bigger than that of short-acting G-CSF group(P=0.018).In terms of mobilization related adverse reactions,the difference between the two groups was not obvious.The implantation time of neutrophil was 11(8-19)days and 10(9-12)days after transplantation in the PEG-rhG-CSF group and the short-acting G-CSF group,and the implantation time of platelet was 11(7-37)days and 11(9-88)days,respectively,with no statistical significance(P=0.546,P=0.570).Conclusions:VP-16 combined with G-CSF has good mobilization and collection effect and good tolerance,which is a safe and effective program for autologous PBSC mobilization in MM patients.Compared with the scheme of VP-16 combined with short-acting G-CSF,the scheme of VP-16 combined with PEG-rhG-CSF has a higher rate of good and good collection,fewer times of collection and shorter time from mobilization to collection,so it may be a better choice.