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Dr. Gertz - Stem Cell Transplant without Growth Factor In Multiple Myeloma: Engraftment Kinetics, Bacteremia, and Hospitalization
Morie Abraham Gertz, MD
Mayo Clinic
Rochester, Minnesota
USA
12.02.10

Morie Abraham Gertz, MD1, Dennis Gastineau, MD2, Martha Lacy, MD2, Angela Dispenzieri, MD2, Suzanne R. Hayman, MD2, Shaji Kumar, MD2, David Dingli, M.D., Ph.D.2, Nelson Leung, MD3, Robert Wolf, PharmD, RPh4, William J Hogan, MBBCh2 and Francis Buadi, MD2

1Mayo Clinic, Rochester, MN
2Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
3Dept. of Nephrology, Mayo Clinic, Rochester, Rochester, MN
4Pharmacy, Mayo Clinic, Rochester, MN

Introduction: Stem cell transplantation is important in the management of multiple myeloma. In the United States, the standard of care is administration of growth factors to accelerate neutrophil recovery after stem cell transplant. The need for growth factors after transplant has not been investigated recently.

Patients: We analyzed a cohort of 166 patients at our institution who underwent autologous transplant for multiple myeloma without receiving growth factors after transplant and compared them with 498 patients who received standard filgrastim beginning on posttransplant day 5.  TABLE

Results: A neutrophil count of 500/μL was achieved in a median of 12.5 days in patients receiving growth factor, compared with 13.5 days in those not receiving growth factor (P<.001) Fig 1. Platelet engraftment was identical (median, 14.5 days; P=.12) in both groups, despite a lower median number of CD34+ cells infused in patients who did not receive growth factors.  Incidence of nonstaphylococcal bacteremia was identical in both groups. The median hospital stay was 3.5 days shorter in the group not receiving growth factor. Bacteremia impacted platelet but not neutrophil engraftment. Figure 2

Conclusion: It is feasible and reasonable to perform autologous stem cell transplant for multiple myeloma without administering growth factors. Estimated savings would be $4,600 for each transplanted patient. Growth factor administration is not required for a safe outcome and decreases the number and severity of some of the fluid-related complications after transplant such as acute respiratory distress syndrome, allergic reactions, alveolar hemorrhage, and rarely splenic rupture.

Table. Patient Characteristics

Patient Group

Characteristic

Filgrastim (n=498)

No Filgrastim (n=166)

P Value

Men

290 (58)

102 (61)

.52

Age, y

59.8 (53.0-65.4)

61 (53.9-66.8)

.25

Serum M spike, g/dL

0.8 (0.1-1.8)

0.6 (0.1-1.8)

.22

Urine total protein, g/24 h

0.10 (0.06-0.33)

0.09 (0.05-0.28)

.67

b2M, mcg/mL

2.56 (1.97-3.71)

2.71 (2.10-3.66)

.13

LDH, units/L

187 (158-229)

184 (152-214)

.35

Myeloma bone disease

422 (85)

146 (88)

.37

Marrow PCs, %

8 (2-21)

8 (2-23)

.60

Radiotherapy

137 (28)

48 (29)

.76

Abnormal metaphase cytogenetics

98 (20) (n=494)

27 (16) (n=165)

.36

Albumin, g/dL

3.7 (3.3-4.0)

3.3 (3.1-3.4)

<.001

Creatinine, mg/dL

1.0 (0.9-1.2)

0.9 (0.8-1.1)

.002

ISS

Stage I

222 (46) (n=481)

21 (13) (n=165)

<.001

Stage II

200 (42)

125 (76)

<.001

Stage III

59 (12)

19 (12)

NA

CD34+ cells infused, ×106 cells/kg

4.33 (3.78-5.51)

4.19 (3.50-5.03)

.01

All-cause mortality before day +100

10 (2)

3 (2)

NA

Figure 1. Patients who received filgrastim achieved neutrophil engraftment faster than those who did not P<.001

Figure 2. Presence of bacteremia had no effect on neutrophil engraftment (p=.28) but slowed the rate of platelet engraftment

Platlets P<.001


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