A combination of dexamethasone, cyclophosphamide, etoposide, and cisplatin is less toxic and more effective than high-dose cyclophosphamide for peripheral stem cell mobilization in multiple myeloma

Alessandro Corso, Luca Arcaini, Sabrina Caberlon, Patrizia Zappasodi, Silvia Mangiacavalli, Angela Lorenzi, Chiara Rusconi, Daniela Troletti, Maria Angela Maiocchi, Cristiana Pascutto, Enrica Morra, Mario Lazzarino

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Abstract

Background and Objectives. The purpose of this study was to compare the efficacy and toxicity of two regimens for peripheral blood stem cell (PBSC) mobilization in multiple myeloma (MM) patients. Design and Methods. From 1995 to 2001, 116 patients were enrolled in two high-dose programs including autologous transplantation, adopting two mobilizing regimens: 61 patients were mobilized with high-dose cyclophosphamide (HD-Cy) at 4 g/m2 (group I), and 55 patients with DCEP (dexamethasone, cyclophosphamide, etoposide, and cisplatin) (group II), both followed by granulocyte colony-stimulating factor (G-CSF 5 μg/Kg/day) started 48 hours after chemotherapy. Results. The median number of CD34+ cells harvested was similar in the two groups (5.9 vs 5.82×106cells/kg). The target of at least 4×106 cells/kg was reached in a higher percentage of patients in the DCEP group (75 vs 59%) (p=0.05). The proportion of poor mobilizers (6 CD34+ cells/kg) was 21% with HD-Cy and 13% with DCEP (P=NS). In group I, 10 patients (16%) required packed red cell transfusions, 5 patients (8%) platelet support, and the majority of patients (87%) had a neutrophil count below 500/μL, whereas none did so in group II (p=0.0009, p=0.01, p=0.0009, respectively). Neutropenia-related fever occurred in 18% of patients in group I versus 0% in group II (p=0.0005). WHO grade >11 extra-hematologic toxicities (microhematuria, cystitis, infections) were seen in 8 patients (13%) of group I vs 0 in group II (p=0.007). Interpretation and Conclusions. DCEP is a better tolerated and more effective regimen than HD-Cy for peripheral stem cell mobilization in MM patients assigned to high-dose therapy programs.

Original languageEnglish
Pages (from-to)1041-1045
Number of pages5
JournalHaematologica
Volume87
Issue number10
Publication statusPublished - Oct 2002

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Keywords

  • DCEP
  • High-dose cyclophosphamide
  • Multiple myeloma
  • Stem cell mobilization

ASJC Scopus subject areas

  • Hematology

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