Autologous stem-cell collection following VTD or VRD induction therapy in multiple myeloma: a single-center experience.

Laurent, Vanille; Fronteau, Clémentine; Antier, Chloé; Dupuis, Pascale; Tessoulin, Benoit; Gastinne, Thomas; Mahé, Béatrice; Blin, Nicolas; Dubruille, Viviane; Lok, Anne; Chevallier, Patrice; Guillaume, Thierry; Garnier, Alice; Peterlin, Pierre; Le Bourgeois, Amandine; Vantyghem, Sophie; Tiab, Mourad; Godmer, Pascal; Sadot, Sophie; Loirat, Marion; Trebouet, Adrien; Cormier, Nicolas; Le Gouill, Steven; Moreau, Philippe; Touzeau, Cyrille

Triplet-drug regimen bortezomib-thalidomide-dexamethasone (VTD) and bortezomib-lenalidomide-dexamethasone (VRD) are considered as standard of care induction prior autologous stem-cell transplantation (ASCT) in myeloma. In addition to improve response rate, induction therapy should preserve an adequate stem-cell collection. In the present retrospective study, we analyzed stem-cell collection in 325 newly diagnosed myeloma patients who received either VTD or VRD induction before ASCT. Stem-cell mobilization consisted of intravenous cyclophosphamide plus G-CSF. Plerixafor was administered preemptively to rescue mobilization. In comparison with VTD, VRD induction was associated with a more frequent use of plerixafor (19.3% versus 5.4%, p = 0.004) and with an increased number of apheresis to reach adequate collection (>2 apheresis required in 42.3% versus 30.2%, p = 0.05). Moreover, more patients experienced collection failure in the VRD group (6% versus 1.8%, p = 0.004). The median number of CD34-positive cells (×106/kg) was lower in the VRD group: 8.5 versus 9.3 (p = 0.05) in the VTD group. The vast majority of patients underwent ASCT (93% versus 98%, in VRD and VTD group, respectively). These data highlight the need of optimal stem-cell collection strategy, especially in the context of tandem transplantation and incorporation of anti-CD38 monoclonal antibody into induction.