Leukemia (2009), 19
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ORIGINAL ARTICLE
International myeloma working group (IMWG) consensus statement and guidelines
regarding the current status of stem cell collection and high-dose therapy for multiple
myeloma and the role of plerixafor (AMD 3100)
S Giralt1, EA Stadtmauer2, JL Harousseau3, A Palumbo4, W Bensinger5, RL Comenzo6, S Kumar7, NC Munshi8, A Dispenzieri7,
R Kyle7, G Merlini9, J San Miguel10, H Ludwig11, R Hajek12, S Jagannath13, J Blade14, S Lonial15, MA Dimopoulos16, H Einsele17,
B Barlogie18, KC Anderson8, M Gertz7, M Attal19, P Tosi20, P Sonneveld21, M Boccadoro4, G Morgan22, O Sezer23, MV Mateos10,
M Cavo24, D Joshua25, I Turesson26, W Chen27, K Shimizu28, R Powles29, PG Richardson8, R Niesvizky30, SV Rajkumar7
and BGM Durie31 on behalf of the IMWG32
1Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston,
TX, USA; 2Bone Marrow and Stem Cell Transplant Program, University of Pennsylvania Abramson Cancer Center, Philadelphia,
PA, USA; 3Department of Hematology, Institute de Biologie, Nantes, France; 4Divisione di Ematologia dell Universita di Torino,
Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Torino, Italy; 5Clinical Research Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA; 6Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, New
York, NY, USA; 7Division of Hematology, Mayo Clinic, Rochester, MN, USA; 8Department of Medical Oncology, Division of
Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA; 9Department of Biochemistry, University Hospital
San Matteo, Italy; 10Department of Hematology, Servicio de Hepatologi´a, Hospital Universitario de Salamanca. CIC, IBMCC
(USAL-CSIC), Spain; 111st Medical Department and Oncology, Wilhelminenspital Der Stat Wien, Vienna, Austria; 12Czech
Myeloma Group and Department of Internal Medicine Fn Brno and LF MM Brno, Czech Republic; 13Department of Medicine,
Multiple Myeloma and Bone Marrow Stem Cell Transplant Program at St Vincent's Catholic Medical Center, New York, NY, USA;
14Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain; 15Department of Hematology and Medical Oncology,
Emory University, Atlanta, GA, USA; 16Department of Clinical Therapeutics, University of Athens School of Medicine, Athens,
Greece; 17Department of Internal Medicine, University of Wurzburg, Wurzburg, Germany; 18Departments of Hematology and
Pathology, MIRT UAMS, Little Rock, AR, USA; 19Departments of Hematology and Biostatistics, Purpan Hospital, Toulouse,
France; 20Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy; 21Erasmus MC, Department of
Hematology, Rotterdam, The Netherlands; 22Department of Hematology/Oncology, The Leukemia and Myeloma Program,
Wimbledon, UK; 23Department of Hematology/Oncology, University of Berlin, Germany; 24Institute of Hematology and Medical
Oncology Seragnoli, Bologna, Italy; 25Bosch Institute, University of Sydney, Royal Prince Alfred Hospital, New South Wales,
Australia; 26Department of Hematology/Medicine Malmo¨ University Hospital, Malmo¨, Sweden; 27Department of Hematology/
Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; 28Department of Internal Medicine,
Nagoya City Midori General Hospital, Nagoya, Japan; 29Department of Hematology/Oncology, Parkside Cancer Centre,
London, UK; 30Center for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York, NY, USA
and 31Aptium Oncology, Inc., Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute,
Los Angeles, CA, USA
Multiple myeloma is the most common indication for high-dose
myeloma especially with the arrival of plerixafor. Herein, is a
chemotherapy with autologous stem cell support (ASCT) in
summary of their deliberations and conclusions.
North America today. Stem cell procurement for ASCT has most
Leukemia advance online publication, 25 June 2009;
commonly been performed with stem cell mobilization using
doi:10.1038/leu.2009.127
colony-stimulating factors with or without prior chemotherapy.
Keywords: myeloma; plerixafor; stem cell collection; high-dose
The target CD34 þ cell dose to be collected as well as the
therapy; IMWG; guidelines
number of apheresis performed varies throughout the country,
but a minimum of 2 million CD34 þ
cells/kg has been
traditionally used for the support of one cycle of high-dose
therapy. With the advent of plerixafor (AMD3100) (a novel stem
cell mobilization agent), it is pertinent to review the current
status of stem cell mobilization for myeloma as well as the role
Introductory overview
of autologous stem cell transplantation in this disease. On June
1, 2008, a panel of experts was convened by the International
Current status of stem cell mobilization in multiple
Myeloma Foundation to address issues regarding stem cell
myeloma
mobilization and autologous transplantation in myeloma in the
Multiple myeloma is the most common indication for high-dose
context of new therapies. The panel was asked to discuss a variety
of issues regarding stem cell collection and transplantation in
chemotherapy with autologous stem cell support (ASCT) in
North America today.1 High-dose therapy with ASCT remains
the treatment associated with the highest complete remission
Correspondence: Dr S Giralt, Department of Blood and Marrow
rate and when compared with conventional chemotherapy is
Transplantation, The University of Texas M.D. Anderson Cancer
associated with improvements in survival. The role of high-dose
Center, 1515 Holcombe Blvd., Unit 423, Houston, TX 77030-4009,
therapy in the context of novel anti-myeloma therapies such as
USA.
thalidomide, bortezomib, lenalidomide and combinations is
E-mail: sgiralt@mdanderson.org
32
being re-explored, but it is likely that high-dose therapy will
See Appendix.
Received 15 January 2009; revised 10 March 2009; accepted 11
remain an important component of frontline and relapsed
March 2009
myeloma therapy for the next 510 years. Table 1 demonstrates

IMWG consensus statement and guidelines
S Giralt et al
2
the myeloma transplant activity as reported to the Center for
Stem cell mobilization for myeloma patients is primarily (but
International Blood and Marrow Transplant Research (CIBMTR)
not exclusively) performed using filgrastim granulocyte-colony
and the European Group for Blood and Marrow Transplant
stimulating factor (GCSF) alone or after cyclophosphamide
(EBMT). Of particular interest is the continued increase in the
chemotherapy. The target CD34 þ cell dose to be collected
number of autotransplants performed for myeloma, even after
as well as the number of apheresis performed varies throughout
the approval of bortezomib and lenalidomide.
the country, but a minimum of 2 million CD34 þ cells/kg has
Stem cell procurement for ASCT has traditionally been guided
been traditionally used for the support of one cycle of high-dose
by one of the two strategies:
therapy.
With the advent of plerixafor (AMD3100), a novel stem cell
(a) Marrow harvesting: involving direct penetration and aspira-
mobilization agent, as well as novel induction regimens, it is
tion of the marrow from the bones (usually the iliac crests)
pertinent to review the current status of stem cell mobilization
through multiple marrow aspirations to collect a total of
for myeloma as well as the role of autologous stem cell
5001000 ml of a blood and marrow mixture.
transplantation in this disease. On 1 June, 2008, a panel of
(b) Stem cell mobilization using colony-stimulating factors with
experts was convened by the International Myeloma Foundation
or without prior chemotherapy.
to address issues regarding stem cell mobilization and auto-
logous transplantation in myeloma. The panel was asked to
Table 2 provides a summary of the current pros and cons of each
discuss a variety of issues regarding stem cell collection and
collection method and the current proportion of patients as
transplantation in myeloma in the context of plerixafor. This
reported to the CIBMTR that undergo each procedure.
article is focused on the current role of ASCT, pros and cons of
current mobilization approaches, factors influencing the success
of collection and ideal cell doses in the context of plerixafor.
Table 1
Transplant activity (a) in North America and Europe as
reported to the centers for international blood and marrow transplant
The impact of novel agents on the stem cell collection process,
research (CIBMTR); (b) in Europe as reported to the European group for
possible mechanisms involved and approaches to improve stem
blood and marrow transplant (EBMT)
cell collection in these patients are not part of this paper but
will be addressed in a separate set of recommendations from
Year of transplant
our group.
(a)
2000
2001
2002
2003
2004
Type of transplant
Issues in stem cell collection
Allogeneic
77
88
65
50
29
Autologous
1311
1529
1657
1822
2021
Is there an optimum CD34 þ cell dose to be infused?
No planned 2nd tx
668
1205
1338
1535
1506
In the setting of allogeneic bone marrow transplantation, the
Planned 2nd auto
134
149
132
154
330
beneficial effects of higher stem cell doses as determined by the
Planned 2nd allo
12
26
35
21
73
numbers of nucleated cells or CD34 þ cells has been confirmed
(b)
2002
2003
2004
2005
2006
in multiple retrospective analysis for both T-cell depleted and
non-T-cell depleted transplants.24 The improvement in out-
Type of transplant
comes is due to decreases in non-relapse mortality from
Allogeneic
297
247
164
513
489
improved hematologic reconstitution and lower rates of infec-
Autologous
4376
4971
5324
5787
5938
tion. However, in the setting of allogeneic peripheral blood stem
Table 2
Pros and Cons of commonly used mobilization strategies in patients with myeloma
Strategy
Frequency used
Pros
Cons
Comments
Single agent filgrastim
Most common
Ease of use
Only moderate CD34 yield
Current gold standard
Cost
No anti-myeloma effect
Effective 480% of time
Minimal toxicity
Predictable
Cyclophosphamide plus
Most common
Predictability
Cytopenias and infectious
Doses over 4 g/m2
filgrastim
chemomobilization
Overcomes lenalidomide
complications
associated with more
used
stem cell effect
Adds costs
toxicity without clear
Well tolerated
Minimal anti-myeloma effect
clinical benefit
Predictable
Resource utilization
Combination
In some selected
Disease control
Toxicity
DTPACE and modified
chemotherapy plus
centers or for
In vivo purging
Cytopenias and infectious
CVAD commonly used.
filgrastim
patients with high
complications
No comparative trials
tumor burden
Cost and delays in eventual
transplantation
Combination growth
Filgrastim and
Theoretical improvement in
Costs
No proven benefit
factors
GMCSF explored
graft composition
GMCSF not available in
now rarely used
Europe
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
3
Table 3
Representative studies of various mobilization strategies1324
References
N mobilization strategy
CD34 collected Â e6 per Kg
Median number of apheresis
13
22 GCSF
5.8
NS
22 Cy+GCSF
33.4
NS
14
18 Cy+GmCSF
6.8
5
22 GCSF
4.9
3
15
25 GCSF (8 mcg/kg/d)
2.8
1
25 GCSF (16 mcg/kg/d)
7.9
1
16
37 Cy+GMCSF
12
NS
34 Cy+GCSF
16
NS
17
28 Cy
21.6
1
49 Cy+Etoposide
22.5
1
18
126 Cy+GCSF
9
2
74 GCSF
9
4
19
31 VAD+GCSF
7.7
1
51 Cy (120 mg/kg)+GCSF
5.9
1
20
15 Cy+peg GCSF (6 mg)
10
1
15 Cy+peg GCSF (12 mg)
7.4
1
15 Cy+GCSF
8.6
1
21
313 VDTPACE
29
22
61 Cy (12 g/m2) +GCSF
5.1
1
26 Cy (34 g/m2)+GCSF
7.7
1
23
13 V+Cy
21
1
24
23 DCEP+pegGCSF
5.7
1
Abbreviations: Cy, cyclophosphamide; GCSF, filgrastim; GMCSF, sargromastin; N, number; NS, not stated; peg GCSF, pegylated filgrastim; VAD,
vincristine, adriamycin, dexamethasone; VDTPACE, bortezomib, dexamethasone, thalidomide, platinum, adriamycin, cyclophosphamide,
cyclophosphamide, etoposide.
cell transplantation, increases in the CD34 þ cell dose
and rate of neutrophil and platelet recovery after myeloablative
infused has not translated into improvement in outcomes in
therapy, the impact of the benefit has been small. However,
most retrospective analysis. On the contrary, high CD34 þ
all these studies have been retrospective and included
cell doses have been associated with increase in risks of
heterogeneous populations of patients receiving a variety of
chronic GVHD and increases in mortality, with the possible
conditioning regimens.
exception of high risk patients receiving reduced intensity
regimens.58
Conclusion. The issue of optimal CD34 dosing in the setting
In the setting of autologous peripheral blood stem cell
of ASCT for myeloma requires a prospective clinical trial
transplantation, CD34 þ cell doses of 43 million/kg have
designed to address this issue. The results of such a study could
been associated with better outcomes, primarily due to faster
alter the current recommendations for both the threshold and
hematologic recovery and lower incidence of infectious and
`optimal CD34 dosing' schedules.
bleeding complications.911 Bensinger et al demonstrated that
infusing doses of o2 million CD34 per kg was associated with
slower hematologic recovery and worse outcomes, whereas
Is there an optimal dose of CD34 þ cells to be
patients receiving 45 million CD34 per kg seemed to have a
collected?
faster robust platelet recovery. These data have been used to
The current minimal threshold CD34 cell dose to be infused
support the current patterns of practice with a minimal dose of 2
is agreed to be X2 million CD34 cells/kg for a single
million CD34 per kg and an `optimal' dose of 46 million
transplant. However, the current optimal dose for ideal platelet
CD34 þ cells/kg or greater.9
recovery is considered to be 46 million CD34 cells/kg.10
Studies addressing the impact of the CD34 þ cell dose have
Persistent thrombocytopenia post-allogeneic SCT has been
been primarily retrospective and have included heterogeneous
associated with severe acute GVHD and poor survival.15
groups of patients receiving a variety of conditioning regimens.
In the setting of autologous transplant, poor platelet recovery
Weaver et al11 in 1995 analysed data on 692 patients. A
post-autologous transplant or secondary platelet failure has
CD34 þ cell dose of 45 million CD34 þ cells/kg appeared to
been observed in 8% of autograft recipients and was seen
be optimal, and only doses of 412.5 million CD34 þ cells were
in the context of CMV infection or in patients receiving
associated with a faster platelet engraftment. Benedetti et al and
bone marrow as a stem cell source. Secondary failures
Ketterer et al have reported that very large numbers of CD34 þ
of platelet recovery were associated with a higher risk of
cells/kg (415 million CD34 þ
cells/kg) after high-dose
death.16
melphalan administration can eliminate severe thrombocyto-
penia and platelet transfusion requirements.12,13 In most studies,
CD34 dose was not associated with different outcomes with the
Conclusion/assessment. The committee suggested that a
exception of a retrospective study performed by Oran et al14
minimum target of 4 million CD34 þ cells/kg be collected and
demonstrating that increasing CD34 doses were associated with
that if feasible an average of 810 million CD34 þ cells/kg
improved outcomes in patients with amyloidosis who under-
be collected. These targets would allow most patients with
went ASCT. Thus, although retrospective analysis suggests a
myeloma to undergo at least two autografts with an optimal
strong doseresponse relationship between CD34 þ cell dose
CD34 dose during the course of their disease.
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
4
Is there a standard collection strategy for patients with
exposure as predictors of mobilization failing to achieve a
multiple myeloma?
minimal dose.2935
Table 3 summarizes the most recent studies looking at a
More recently, exposure to lenalidomide has been associated
variety of strategies for stem cell collection in myeloma. Most of
with failure to mobilize adequate numbers of stem cells using
these studies have been retrospective and involved small
growth factors alone. This inability to collect may be overcome
number of patients.1728 Notwithstanding these drawbacks, the
by chemomobilization.3134 This may have an impact on the
following conclusions are reasonable based on the evidence
choice of induction therapy. It should be noted, however, that
available:
preliminary data indicate successful harvest with the addition of
plerixafor in 85% of 50 patients previously treated with
Conclusion/assessment
lenalidomide who failed to collect X2 million CD34 þ cells
with G-CSF alone (preliminary findings: CUP post hoc analysis).
(a) Both GCSF alone (non-pegylated) or chemotherapy fol-
Likewise, the negative effects of limited melphalan exposure
lowed by GCSF are reasonable strategies for stem cell
should also be revisited due to the impressive results of
collection. The data regarding stem cell collection after
melphalan in combination with bortezomib, thalidomide, or
single agent pegylated GCSF is much more limited than for
lenalidomide.35,36 Table 4 summarizes the known risk factors and
non-pegylated GCSF, but supports the use of this agent for
potential strategies to enhance stem cell collection when present.
stem cell collection.
(b) Most trials suggest that more CD34 þ cells can be collected
after chemomobilization than after GCSF only mobilization.
What will be the impact of plerixafor on stem cell
However, the failure rate (in terms of `minimal collection
collection strategies in myeloma?
criteria' noted above) with chemomobilization is similar
Plerixafor is a bicyclam molecule that inhibits the SDF-1 alpha/
to the failure rate with GCSF alone. In addition, chemo-
CXCR4 binding that occurs between CD34 þ stem cells and the
mobilization has not demonstrated superior outcomes.18
marrow stroma. The inhibition of this interaction results in the
(c) Higher doses of cyclophosphamide are associated with more
release of CD34 þ stem cells into the blood stream facilitating
toxicity, and doses over 4 g/m2 probably offer no benefit.
their collection through apheresis methods.37 Plerixafor in
(d) Novel mobilization strategies need to be further explored
combination with GCSF resulted in increased CD34 þ cell
looking at improving yields, efficiency, and cost issues.
mobilization and was shown to be effective in mobilizing
(e) Impact of novel mobilization strategies on graft constitution
adequate stem cells in patients who had failed traditional
and the relevance of graft constitution to transplant
mobilization techniques (Hard to Mobilize). Plerixafor also
outcomes also require further research.
decreased the number of apheresis procedures needed to reach
(f) Collections should be attempted between the second and
the target CD34 þ cell dose in most patients.38 Plerixafor in
fourth induction cycle regardless of response to therapy. In
combination with GCSF has also been shown to be more
patients who have primary refractory myeloma without
effective as an initial mobilizing regimen than GCSF alone in
response to combinations including novel agents, mobiliza-
patients with multiple myeloma.39 The combination of plerix-
tion with chemotherapy and GCSF is the practice.
afor plus GCSF resulted in 72% of patients achieving a
collection goal of 6 million or more CD34 þ per kg in 2 or
What factors predict successful stem cell collection?
fewer apheresis procedures versus only 34% for patients
Very few studies have systematically assessed all known risk
receiving GCSF and placebo. Patients achieved X6 million
factors that can impact stem cell collection. Most retrospective
CD34 þ cells/kg in a median of 3 fewer days with plerixafor
studies addressing mobilization have identified patient age,
versus G-CSF alone, and collected 3 Â as many cells on day 1
method of mobilization, time to stem cell mobilization, number
than with G-CSF alone (median 6.86 million versus 2.29
of prior regimens, and prior melphalan and/or radiation
million).40 See Table 5 for the potential benefits of plerixafor.
Table 4
Risk factors for poor stem cell mobilization and potential strategies to overcome them
Risk factor
Age
Patients over 60 years of age have inferior stem
Consider plerixafor mobilization
cell mobilization
Melphalan exposure
Melphalan exposure has traditionally been
Observation needs to be confirmed in the context of novel
associated with poor stem cell collection
therapies. Current practice of avoiding melphalan should
continue until studies performed
In patients with history of melphalan exposure consider upfront
chemomobilization or plerixafor
Extensive prior therapy
Collection failures are associated with disease
Consider harvesting early in the course of the disease even in
or prolonged disease
duration and extent of prior therapy
patients opting out of early high-dose therapy consolidation
duration
Consider upfront plerixafor or chemomobilization
Assess marrow for secondary dysplastic changes before to
collection (that is, morphology and cytogenetics)
Extensive radiotherapy
Collection failures increase
Consider collection before radiotherapy
to marrow bearing tissue
Consider upfront plerixafor or chemomobilization
Assess marrow for secondary dysplastic changes before
collection (that is, morphology and cytogenetics)
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
5
Table 5
Potential benefits of plerixafor
looking at optimizing collection strategies after exposure to novel
therapies (particularly lenalidomide-based combinations) with
Improved collection predictability
plerixafor and G-CSF or plerixafor plus chemotherapy.
K
The addition of plerixafor resulted in a median 4.8-fold increase
There is considerable interest in the role of novel transplant
in circulating CD34+ cells in the peripheral blood, allowing
approaches combined with the new induction strategies. Longer
patients and doctors to predictably schedule apheresis sessions
term follow-up is required to assess the ultimate impact of the
K
Myeloma patients who received plerixafor achieved 3 Â as
various approaches to therapy.
many cells on day 1 than with G-CSF alone (median 6.86 million
In the United States, certain financial considerations also need
versus 2.29 million)
to be taken into account particularly that some third party payers
Reduction of SCT costs by
(that is, Medicare and some private insurance carriers) do not
K
Using less resources (that is, less apheresis procedures)
pay for `harvest and hold' nor is tandem autografting routinely
K
In the phase III study, plerixafor patients achieved X6 million
covered.
CD34+ cells/kg in a median of 3 fewer days with plerixafor
versus G-CSF alone
Under what circumstances is double autologous
Potential of collecting more cells which
K
Allows for more frequent use of high-dose therapy with stem cell
transplant considered, for example, as part of a
support as salvage treatment
protocol?
K
Allows for exploration of improving stem cell transplant
Although various randomized trials and retrospective analysis
outcomes by exploring megadoses of CD34+ cells (that is, 410
have shown that tandem autologous transplant have a superior
million CD34 per kg)
event-free survival than single transplants, the benefit may not
Allows for collecting patients previously exposed to high-dose therapy
apply in the era of novel therapies.4244 Likewise, the benefit
of tandem transplants may be limited to patients failing to
achieve at least a 90% reduction of tumor burden after the
The use of plerixafor was both safe and predictable (in terms of
initial induction and first high-dose therapy consolidation.42,43
cell yields) as a mobilization agent.
Second, the use of post-transplant maintenance with thalido-
mide may abrogate the benefits of a second autograft as
Conclusion/assessment. The committee recognized that
demonstrated by Abdelkafi et al.45 The use of second autologous
more studies needed to be done with this agent to better define
transplants as salvage therapy for some patients has been shown
its role in the treatment of myeloma. These studies need
to result in long disease-free intervals in patients with long
to incorporate pharmacoeconomics and resource utilization
remission after their first autograft.46
endpoints.
The committee recognized that the role of tandem transplan-
tation will need to be reevaluated in the era of IMID's and
proteosome inhibitors. This can only be done in the context
What will be the role of high-dose therapy and
of well done prospective trials. Recent meta-analysis, as well
autologous stem cell transplant for myeloma in the era
as post hoc analysis of previously performed randomized
of novel therapies?
trials have been criticized due to lack of statistical power or
The current paradigm for therapy in multiple myeloma involves
methodologic flaws.47,48
determining whether a patient is considered a potential
candidate for high-dose therapy consolidation or not. Patients
Conclusion/assessment. The consensus of the advisory
who are considered candidates for high-dose therapy receive
board was that double autologous transplant has a place in
induction therapies without melphalan (to prevent stem cell
clinical trials, primarily in younger patients. In practice, a
damage). After an average of 24 cycles, stem cells are collected
second transplant may be replaced by novel agents, or be
and most patients proceed to high-dose melphalan therapy
considered, for example, if there was no response to therapy
followed by autologous stem cell infusion.
with novel agents and a first transplant. High response rates with
This paradigm is supported by the results of multiple
combination therapies including bortezomib, lenalidomide,
randomized trials demonstrating a higher complete remission
thalidomide, and alkylators were noted.
rate and longer event-free survival in high-dose therapy recipi-
The age limit for transplant was also discussed in the context
ents.41 With the advent of novel induction therapies containing
of a delayed transplant translating into older patients receiving
either bortezomib, lenalidomide or combinations that result in
high-dose therapy as salvage therapy. The differences between
complete remission rates of up to 30% and VGPR rates of over
North America and Europe were noted, and the fact that age per
50%, the role of both single and tandem high-dose therapy
se is not an adequate criterion for determining therapy was
consolidation for transplant eligible patients needs to be re-
noted. Further study of plerixafor and GCSF mobilization is
explored in the context of well designed clinical trials. An
particularly warranted in older myeloma patients deemed
important aspect of new trials will be the role of planned up front
eligible for high-dose therapy.
transplant versus transplant at the time of subsequent relapse. In
addition, the value of a major response, such as VGPR, using
novel induction strategies and the subsequent need to perform
Is mini allogeneic transplant still a research therapy?
transplantation or not deserve further study. Both the timing and
The committee agreed that this strategy may be useful for some
number of transplants recommended continue to be controversial.
young patients with compatible siblings depending on the
patient's response to therapy and other prognostic factors. The
Conclusion/assessment. The general consensus from the
current literature provides conflicting data. The results of
advisory board was that high-dose melphalan was still recom-
the prospective IFM trials in high risk patients demonstrated
mended for eligible patients, and that stem cell collection early in
no benefit for an auto/mini allo strategy in regards to overall and
the course of therapy should be attempted in all transplant
event-free survival.49 These results contrast with retrospective
eligible patients. The advisory board recommended more studies
analysis demonstrating a potential benefit of allografting for
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
6
some subsets of patients with specific cytogenetics abnormal-
Harousseau: Received Honoraria from Genzyme and Amgen,
ities and cannot be compared with the results obtained by the
Advisory Board for Celgene and Janssen-Cilag; A Palumbo:
Italian group that demonstrated a survival and event-free
Advisory Board for Ortho Biotech and Celgene; W Bensinger:
survival benefit for recipients of the auto/mini allo approach as
Advisory Board for Celgene and Millennium, Research funding
the Italian study included all patients in their analysis.50 The
from Genzyme, Millennium, Celgene, AstraZeneca and
Spanish Group performed a study looking at the role of a second
Novartis; R Comenzo: Advisory Board for Millennium and
autograft versus a reduced intensity allograft in patients failing to
Ortho Biotech; S Kumar: Clinical trial funding from Celgene,
achieve a very good partial response after initial induction
Millennium, Genzyme; N Munshi: Advisory Board for Celgene;
therapy and high dose consolidation and reported a higher CR
R Kyle: No disclosures; J San Miguel: Advisory Board for
rate for the recipients of the reduced intensity allograft, but no
Millennium, Janssen-Cilag, and Celgene; H Ludwig: Clinical
improvement in survival.51 Allografting has been reported to
trial funding from Schering-Plough, Janssen-Cilag, and partici-
change the prognostic implications of some of the poor risk
pation in Speaker's Bureau for Amgen, Roche, Janssen-Cilag;
cytogenetic profiles.52
J Blade: Honorarium for lectures and Advisory Board for
Celgene, Janssen-Cilag. Research grant from Celgene; S Lonial:
Conclusion/assessment. All these studies involved rela-
Consultant for Millennium, Celgene, Novartis, and BMS; H
tively small number of patients, the large North American Trial
Einsele: Advisory Board for Celgene and Ortho Biotech; P Tosi:
performed through the Blood and Marrow Transplant Clinical
No disclosures; P Sonneveld: Advisory Board for Ortho Biotech
Trials Network will provide invaluable information regarding
and Celege; O Sezer: Clinical trial/research funding from
this issue, but the results will not be available for 2 years. In the
Janssen-Cilag, Merck, and Novartis. Speaker's Bureau for
meantime, allografting should continue to be explored in the
Amgen, Celgene, Merck, Novartis, Ortho Biotech, Pharmion,
context of clinical trials in carefully selected patients as frontline
and Roche; M Cavo: No disclosures; P Richardson: Advisory
therapy or as salvage therapy.
Board for Celgene and Millennium; SV Rajkumar: No dis-
closures; B Durie: Advisory Board for Celgene and Millennium.
What are the main goals of autologous transplant?
As for other forms of therapy, the goals of autologous transplant
References
are to achieve the maximum depth and duration of response
leading to the best overall survival.
1 Pasquini MC, He V, Perez WS. CIBMTR summary slides part 1.
The target depth of response surrogate varies from trial to trial.
CIBMTR Newsletter 2006; 12: 57.
Although CR is a target, the new uniform response criteria
2 Mavroudis D, Read E, Cottler-Fox M, Couriel D, Molldrem J, Carter
C et al. CD34+ cell dose predicts survival, posttransplant
identify VGPR plus CR as a better collective category for cross-
morbidity, and rate of hematologic recovery after allogeneic
trial comparisons. In addition, stringent CR (sCR) may prove to
marrow transplants for hematologic malignancies. Blood 1996; 88:
be a more decisive and predictive endpoint.53
32233229.
It is recognized that PR and/or VGPR populations can include
3 Bittencourt H, Rocha V, Chevret S, Socie´ G, Espe´rou H, Devergie
patients with post-therapy MGUS states with a good prognosis.
A et al. Association of CD34 cell dose with hematopoietic
Thus, detailed prognostic factor and risk assessment are required
recovery, infections, and other outcomes after HLA-identical
sibling bone marrow transplantation. Blood 2002; 99: 27262733.
to fully evaluate short- and long-term outcomes.
4 Sierra J, Storer B, Hansen JA, Bjerke JW, Martin PJ, Petersdorf EW
et al. Transplantation of marrow cells from unrelated donors for
treatment of high-risk acute leukemia: the effect of leukemic
Executive summary
burden, donor HLA-matching, and marrow cell dose. Blood 1997;
89: 42264235.
Multiple myeloma is the most common indication for ASCT in
5 Przepiorka D, Smith TL, Folloder J, Khouri I, Ueno NT, Mehra R
the world today. Its role in the context of novel therapies,
et al. Risk factors for acute graft-versus-host disease after allogeneic
blood stem cell transplantation. Blood 1999; 94: 14651470.
however, is currently being re-explored. Although high-dose
6 Perez-Simon JA, Diez-Campelo M, Martino R, Sureda A, Caballero
therapy will remain an important component of anti-myeloma
D, Canizo C et al. Impact of CD34+ cell dose on the outcome of
therapy, whether it will be considered as consolidation for all
patients undergoing reduced-intensity-conditioning allogeneic
eligible patients or used more as salvage therapy remains to be
peripheral blood stem cell transplantation. Blood 2003; 102:
defined. Notwithstanding, optimizing stem cell collection either
11081113.
early or later in the course of the disease will be an integral
7 Zaucha R, Gooley T, Bensinger WI, Heimfeld S, Chauncey TR,
Zaucha R et al. CD34 cell dose in granulocyte colony-stimulating
component of myeloma treatment planning. The advent of
factor-mobilized peripheral blood mononuclear cell grafts affects
Plerixafor (a novel stem cell mobilization agent) as well as novel
engraftment kinetics and development of extensive chronic graft-
induction regimens will likely change the current standards for
versus-host disease after human leukocyte antigen-identical sibling
stem cell transplant and mobilization. How these standards will
transplantation. Blood 2001; 98: 32213227.
change depend on the result of current and future prospective
8 Mohty M, Bilger K, Jourdan E, Kuentz M, Michallet M, Bourhis JH
trials. Likewise, current standards regarding optimal CD34 dose
et al. Higher doses of CD34+ peripheral blood stem cells are
associated with increased mortality from chronic graft-versus-host
for autografting in myeloma may need to be re-explored
disease after allogeneic HLA-identical sibling transplantation.
particularly if prospective trials determine that higher doses of
Leukemia 2003; 17: 869875.
CD34 þ cells impact patient outcomes (such as quality of life,
9 Desikan KR, Tricot G, Munshi NC, Annaissie E, Spoon D, Fassas A
post-transplant symptom burden, and hematopoietic recovery).
et al. Preceding chemotherapy, tumour load and age influence
engraftment in multiple myeloma patients mobilized with granu-
locyte colony-stimulating factor alone. Br J Haematol 2001; 112:
Conflict of interest
242247.
10 Bensinger W, Appelbaum F, Rowley S, Storb R, Sanders J, Lilleby K
et al. Factors that influence collection and engraftment of
S Giralt: Advisory Board for Celgene, Millennium, Novartis, and
autologous peripheral blood-stem cells. J Clin Oncol 1995; 13:
Genzyme; E Stadtmauer: Advisory Board for Genzyme; J
25472555.
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
7
11 Weaver CH, Hazelton B, Birch R, Palmer P, Allen C, Schwartzberg
plantation compared with low-dose CY in patients with multiple
L et al. An analysis of engraftment kinetics as a function of the
myeloma. Cytotherapy 2007; 9: 539547.
CD34 content of peripheral blood progenitor cell collections in
27 Zappasodi P, Nosari AM, Astori C, Ciapanna D, Bonfichi M,
692 patients after the administration of myeloablative chemo-
Varettoni M et al. DCEP chemotherapy followed by a single, fixed
therapy. Blood 1995; 86: 39613969.
dose of pegylated filgrastim allows adequate stem cell mobil-
12 Benedetti G, Patoia L, Giglietti A, Alessio M, Pelicci P, Grignani F.
ization in multiple myeloma patients. Transfusion 2008; 48:
Very large amounts of peripheral blood progenitor cell eliminate
857860.
severe thrombocytopenia after high-dose melphalan in advan-
28 Pelus LM. Peripheral blood stem cell mobilization: new regimens,
ced breast cancer patients. Bone Marrow Transplant 1999; 24:
new cells, where do we stand. Curr Opin Hemato 2008; 15:
971979.
285292.
13 Ketterer N, Salles G, Raba M, Espinouse D, Sonet A, Tremisi P
29 Perea G, Sureda A, Martino R, Alte´s A, Marti´nez C, Cabezudo E
et al. High CD34+ cell counts decrease hematologic toxicity of
et al. Predictive factors for a successful mobilization of peripheral
autologous peripheral blood progenitor cell transplantation. Blood
blood CD34+ cells in multiple myeloma. Ann Hematol 2001; 80:
1998; 91: 31483155.
592597.
14 Oran B, Malek K, Sanchorawala V, Wright DG, Quillen K, Finn KT
30 de la Rubia J, Blade J, Lahuerta JJ, Ribera JM, Marti´nez R, Alegre A
et al. Predictive factors for hematopoietic engraftment after
et al. Effect of chemotherapy with alkylating agents on the yield of
autologous peripheral blood stem cell transplantation for AL
CD34+ cells in patients with multiple myeloma. Results of the
amyloidosis. Bone Marrow Transplant 2005; 35: 567575.
Spanish Myeloma Group (GEM) Study. Haematologica 2006; 91:
15 Kim DH, Sohn SK, Jeon SB, Baek JH, Kim JG, Lee NY et al.
621627.
Prognostic significance of platelet recovery pattern after allogeneic
31 Kumar S, Dispenzieri A, Lacy MQ, Hayman SR, Fuadi SK,
HLA-identical sibling transplantation and its association with
Gastineau DA et al. Impact of lenalidomide therapy on stem cell
severe acute GVHD. Bone Marrow Transplant 2006; 37: 101108.
mobilization and engraftment post-peripheral blood stem cell
16 Bruno B, Gooley T, Sullivan KM, Davis C, Bensinger WI, Storb R
transplantation in patients with newly diagnosed myeloma.
et al. Secondary failure of platelet recovery after hematopoietic
Leukemia 2007; 21: 20352042.
stem cell transplantation. Biol Blood Marrow Transplant 2001; 7:
32 Mazumder A, Kaufman J, Niesvizky R, Lonial S, Vesole D,
154162.
Jagannath S. Effect of lenalidomide therapy on mobilization of
17 Desikan KR, Barlogie B, Jagannath S, Vesole DH, Siegel D, Fassas
peripheral blood stem cells in previously untreated multiple
A et al. Comparable engraftment kinetics following peripheral-
myeloma patients. Leukemia 2007; 22: 12801281.
blood stem-cell infusion mobilized with granulocyte colony-
33 Paripati H, Stewart AK, Cabou S, Dueck A, Zepeda VJ, Pirooz N
stimulating factor with or without cyclophosphamide in multiple
et al. Compromised stem cell mobilization following induction
myeloma. J Clin Oncol 1998; 16: 15471553.
therapy with lenalidomide in myeloma. Leukemia 2008; 22:
18 Alegre A, Toma´s JF, Marti´nez-Chamorro C, Gil-Ferna´ndez JJ,
12821284.
Ferna´ndez-Villalta MJ, Arranz R et al. Comparison of peripheral
34 Mark T, Stern J, Furst J, Jayabalan D, Zafar F, LaRow A et al.
blood progenitor cell mobilization in patients with multiple
Stem cell mobilization with cyclophosphamide overcomes the
myeloma: high-dose cyclophosphamide plus GM-CSF vs G-CSF
suppressive effect of lenalidomide therapy on stem cell collection
alone. Bone Marrow Transplant 1997; 20: 211217.
in multiple myeloma. Biol Blood Marrow Transplant 2008; 14:
19 Demirer T, Ayli M, Ozcan M, Gunel N, Haznedar R, Dagli M et al.
795798.
Mobilization of peripheral blood stem cells with chemotherapy
35 Tricot G, Jagannath S, Vesole D, Nelson J, Tindle S, Miller L et al.
and recombinant human granulocyte colony-stimulating factor
Peripheral blood stem cell transplants for multiple myeloma:
(rhG-CSF): a randomized evaluation of different doses of rhG-CSF.
identification of favorable variables for rapid engraftment in 225
Br J Haematol 2002; 116: 468474.
patients. Blood 1995; 85: 588596.
20 Arora M, Burns LJ, Barker JN, Miller JS, Defor TE, Olujohungbe AB
36 Palumbo A, Bringhen S, Liberati AM, Caravita T, Falcone A,
et al. Randomized comparison of granulocyte colony-stimulating
Callera V et al. Oral melphalan, prednisone, and thalidomide in
factor versus granulocyte-macrophage colony-stimulating factor
elderly patients with multiple myeloma: updated results of a
plus intensive chemotherapy for peripheral blood stem cell
randomized, controlled trial. Blood 2008; 112: 31073114.
mobilization and autologous transplantation in multiple myeloma.
37 Mateos MV, Herna´ndez JM, Herna´ndez MT, Gutie´rrez NC,
Biol Blood Marrow Transplant 2004; 10: 395404.
Palomera L, Fuertes M et al. Bortezomib plus melphalan and
21 Gojo I, Guo C, Sarkodee-Adoo C, Meisenberg B, Fassas A,
prednisone in elderly untreated patients with multiple myeloma:
Rapoport AP et al. High-dose cyclophosphamide with or without
updated time-to-events results and prognostic factors for time to
etoposide for mobilization of peripheral blood progenitor cells in
progression. Haematologica 2008; 93: 560565.
patients with multiple myeloma: efficacy and toxicity. Bone
38 Grignani G, Perissinotto E, Cavalloni G, Carnevale Schianca F,
Marrow Transplant 2004; 34: 6976.
Aglietta M. Clinical use of AMD3100 to mobilize CD34+ cells in
22 Dingli D, Nowakowski GS, Dispenzieri A, Lacy MQ, Hayman S,
patients affected by non-Hodgkin's lymphoma or multiple
Litzow MR et al. Cyclophosphamide mobilization does not
myeloma. J Clin Oncol 2005; 23: 38713872.
improve outcome in patients receiving stem cell transplantation
39 Flomenberg N, Devine SM, Dipersio JF, Liesveld JL, McCarty JM,
for multiple myeloma. Clin Lymphoma Myeloma 2006; 6:
Rowley SD et al. The use of AMD3100 plus G-CSF for autologous
384388.
hematopoietic progenitor cell mobilization is superior to G-CSF
23 Lefre`re F, Zohar S, Ghez D, Delarue R, Audat F, Suarez F et al. The
alone. Blood 2005; 106: 18671874.
VAD chemotherapy regimen plus a G-CSF dose of 10 microg/kg is
40 Dipersio JF, Stadtmauer EA, Nademanee AP, Stiff P, Micallef I,
as effective and less toxic than high-dose cyclophosphamide plus a
Angell J et al. A phase III, multicenter, randomized, double-blind,
G-CSF dose of 5 microg/kg for progenitor cell mobilization: results
placebo-controlled, comparative trial of AMD3100 (Perixafor) +
from a monocentric study of 82 patients. Bone Marrow Transplant
G-CSF vs G-CSF + placebo for mobilization in multiple myeloma
2006; 37: 725729.
(MM) patients for autologous hematopoietic stem cell (aHSC)
24 Bruns I, Steidl U, Kronenwett R, Fenk R, Graef T, Rohr UP et al. A
transplantation. Blood 2007; 110 abstract 445, 137a.
single dose of 6 or 12 mg of pegfilgrastim for peripheral blood
41 Koreth J, Cutler CS, Djulbegovic B, Behl R, Schlossman RL, Munshi
progenitor cell mobilization results in similar yields of CD34+
NC, Richardson PG et al. High-dose therapy with single
progenitors in patients with multiple myeloma. Transfusion 2006;
autologous transplantation versus chemotherapy for newly diag-
46: 180185.
nosed multiple myeloma: a systematic review and meta-analysis of
25 Barlogie B, Anaissie E, van Rhee F, Pineda-Roman M, Zangari M,
randomized controlled trials. Biol Blood Marrow Transplant 2007;
Shaughnessy J et al. The Arkansas approach to therapy of patients
3: 183196.
with multiple myeloma. Best Pract Res Clin Haematol 2007; 20:
42 Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG
761781.
et al. Single versus double autologous stem-cell transplantation for
26 Hiwase DK, Bollard G, Hiwase S, Bailey M, Muirhead J, Schwarer
multiple myeloma. N Engl J Med 2003; 349: 24952502.
AP. Intermediate-dose CY and G-CSF more efficiently mobilize
43 Cavo M, Tosi P, Zamagni E, Cellini C, Tacchetti P, Patriarca F et al.
adequate numbers of PBSC for tandem autologous PBSC trans-
Prospective, randomized study of single compared with double
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
8
autologous stem-cell transplantation for multiple myeloma:
49 Garban F, Attal M, Michallet M, Hulin C, Bourhis JH, Yakoub-
Bologna 96 clinical study. J Clin Oncol 2007; 25: 24342441.
Agha I et al. Prospective comparison of autologous stem cell
44 Barlogie B, Tricot GJ, van Rhee F, Angtuaco E, Walker R, Epstein J
transplantation followed by dose-reduced allograft (IFM99-03 trial)
et al. Long-term outcome results of the first tandem autotransplant
with tandem autologous stem cell transplantation (IFM99-04
trial for multiple myeloma. Br J Haematol 2006; 135: 158164.
trial) in high-risk de novo multiple myeloma. Blood 2006; 107:
45 Abdelkafi A, Ladeb S, Torjman L, Othman TB, Lakhal A,
34743480.
Romdhane NB et al. Single autologous stem-cell transplantation
50 Bruno B, Rotta M, Patriarca F, Mordini N, Allione B, Carnevale-
followed by maintenance therapy with thalidomide is superior
Schianca F et al. A comparison of allografting with autografting
to double autologous transplantation in multiple myeloma:
for newly diagnosed myeloma. N Engl J Med 2007; 356:
results of a multicenter randomized clinical trial. Blood 2008;
11101120.
111: 18051810.
51 Rosin~ol L, Pe´rez-Simo´n JA, Sureda A, de la Rubia J, de Arriba F,
46 Mehta J, Tricot G, Jagannath S, Ayers D, Singhal S, Siegel D et al.
Lahuerta JJ et al. A prospective PETHEMA study of tandem
Salvage autologous or allogeneic transplantation for multiple
autologous transplantation versus autograft followed by reduced-
myeloma refractory to or relapsing after a first-line autograft. Bone
intensity conditioning allogeneic transplantation in newly diag-
Marrow Transplant 1998; 21: 887892.
nosed multiple myeloma. Blood 2008; 112: 35913593.
47 Kumar A, Kharfan-Dabaja MA, Glasmacher A, Djulbegovic B.
52 Schilling G, Hansen T, Shimoni A, Zabelina T, Pe´rez-Simo´n JA,
Tandem versus single autologous hematopoietic cell transplanta-
Gutierrez NC et al. Impact of genetic abnormalities on survival
tion for the treatment of multiple myeloma: a systematic review
after allogeneic hematopoietic stem cell transplantation in multi-
and meta-analysis. J Natl Cancer Inst 2009; 21: 100106.
ple myeloma. Leukemia 2008; 22: 12501255.
48 Mehta J, Singhal S. Current status of autologous hematopoietic
53 Durie BGM, Harousseau JL, Miguel JS, Blade´ J, Barlogie B,
stem cell transplantation in myeloma. Bone Marrow Transplant
Anderson K et al. International uniform response criteria for
2008; 42 (Suppl 1): S28S34.
multiple myeloma. Leukemia 2008; 20: 14671473.
Appendix
Jean-Paul Fermand, Hopitaux de Paris, Paris, France
Rafael Fonseca, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
International Myeloma Working Group
Gosta Gahrton, Karolinska Institute for Medicine, Huddinge,
Sweden
Rafat Abonour, Indiana University School of Medicine,
Morie Gertz, Mayo Clinic, Rochester, MN, USA
Indianapolis, IN, USA
John Gibson, Royal Prince Alfred Hospital, Sydney, Australia
Ray Alexanian, MD Anderson, Houston, TX, USA
Hartmut
Goldschmidt,
University
Hospital
Heidelberg,
Kenneth Anderson, DFCI, Boston, MA, USA
Heidelberg, Germany
Michael Attal, Purpan Hospital, Toulouse, France
Philip Greipp, Mayo Clinic, Rochester, MN, USA
Herve Avet-Loiseau, Institute de Biologie, Nantes, France
Roman Hajek, Brno University, Brno, Czech Republic
Ashraf Badros, University of Maryland, Baltimore, MD, USA
Izhar Hardan, Tel Aviv University, Tel Aviv, Israel
Leif Bergsagel, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
Jean-Luc Harousseau, Institute de Biologie, Nantes, France
Joan Blade´, Hospital Clinica, Barcelona, Spain
Hiroyuki Hata, Kumamoto University Hospital, Kumamoto,
Bart Barlogie, M.I.R.T. UAMS Little Rock, AR, USA
Japan
Regis Batille, Institute de Biologie, Nantes, France
Yutaka Hattori, Keio University School of Medicine, Tokyo,
Meral Beksac, Ankara University, Ankara, Turkey
Japan
Andrew Belch, Cross Cancer Institute, Alberta, Canada
Joy Ho, Royal Prince Alfred Hospital, Sydney, Australia
Bill Bensinger, Fred Hutchinson Cancer Center, Seattle, WA,
Vania Hungria, Clinica San Germano, Sao Paolo, Brazil
USA
Shinsuke Ida, Nagoya City University Medical School, Nagoya,
Mario Boccadoro, University of Torino, Torino, Italy
Japan
Michele Cavo, Universita di Bologna, Bologna, Italy
Peter Jacobs, Constantiaberg Medi-Clinic, Plumstead, South
Wen Ming Chen, MM Research Center of Beijing, Beijing, China
Africa
Tony Child, Leeds General Hospital, Leeds, United Kingdom
Sundar Jagannath, St Vincent's Comprehensive Cancer Center,
James Chim, Department of Medicine, Queen Mary Hospital,
New York, NY, USA
Hong Kong
Hou Jian, Shanghai Chang Zheng Hospital, Shanghai, China
Ray Comenzo, Memorial Sloane-Kettering, New York City, NY,
Douglas Joshua, Royal Prince Alfred Hospital, Sydney, Australia
USA
Michio Kawano, Yamaguchi University, Ube, Japan
John Crowley, Cancer Research and Biostatistics, Seattle, WA,
Nicolaus Kro¨ger, University Hospital Hamburg, Hamburg,
USA
Germany
William Dalton, H. Lee Moffitt, Tampa, FL, USA
Shaji Kumar, Department of Hematology, Mayo Clinic, MN,
Faith Davies, Royal Marsden Hospital, London, England
USA
Ca´rmino de Souza, Univeridade de Campinas, Caminas, Brazil
Robert Kyle, Department of Laboratory Med. and Pathology,
Michel Delforge, University Hospital Gasthuisberg, Leuven,
Mayo Clinic, MN, USA
Belgium
Juan
Lahuerta,
Grupo
Espanol
di
Mieloma,
Hospital
Meletios Dimopoulos, Alexandra Hospital, Athens, Greece
Universitario, Madrid, Spain
Angela Dispenzieri, Mayo Clinic, Rochester, MN, USA
Jae Hoon Lee, Gachon University Gil Hospital, Incheon, Korea
Brian GM Durie, Cedars-Sinai Outpatient Cancer Center,
Xavier LeLeu, Hospital Huriez, CHRU Lille, France
Los Angeles, CA, USA
Suzanne Lentzsch, UPMC Cancer Pavillion, Pittsburgh, PA, USA
Hermann Einsele, Universita¨tsklinik Wu¨rzburg, Wu¨rzburg,
Henk Lokhorst, University Medical Center Utrecht, Utrecht,
Germany
The Netherlands
Thierry Facon, Centre Hospitalier Regional Universitaire de
Sagar Lonial, Emory University School of Medicine, Atlanta, GA,
Lille, Lille, France
USA
Dorotea Fantl, Socieded Argentinade Hematolgia, Buenos Aires,
Heinz Ludwig, Wilhelminenspital Der Stat Wien, Vienna,
Argentina
Austria
Leukemia

IMWG consensus statement and guidelines
S Giralt et al
9
Angelo Maiolino, Rua fonte da Saudade, Rio de Janeiro, Brazil
Jesus San Miguel, University of Salamanca, Salamanca, Spain
Mari´a-Victoria Mateos, University Hospital of Salamanca, Spain
Chaim Shustik, McGill, Toronto, Canada
Jayesh Mehta, Northwestern University, Chicago, IL, USA
Seema Singhal, Northwestern University, Chicago, IL, USA
GianPaolo Merlini, University of Pavia, Pavia, Italy
Pieter Sonneveld, Erasmus MC, Rotterdam, The Netherlands
Joseph Mikhael, Mayo Clinic, Scottsdale, AZ, USA
Andrew Spencer, The Alfred Hospital, Melbourne, Australia
Philippe Moreau, University Hospital, Nantes, France
Edward Stadtmauer, University of Pennsylvania, Philadelphia,
Gareth Morgan, Royal Marsden Hospital, London, England
PA, USA
Nikhil Munshi, Diane Farber Cancer Institute, Boston, MA, USA
Keith Stewart, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
Yana Novis, Hospital Si´rioLibane^s, Bela Vista, Brazil
Patrizia Tosi, Italian Cooperative Group, Istituto di Ematologia
Amara Nouel, Hospital Rutz y Paez, Bolivar, Venezuela
Seragnoli, Bologna, Italy
Robert Orlowski, MD Anderson, Houston, TX, USA
Guido Tricot, Huntsman Cancer Institute, Salt Lake City, UT,
Antonio Palumbo, Cathedra Ematologia, Torino, Italy
USA
Santiago Pavlovsky, Fundaleu, Buenos Aires, Argentina
Ingemar
Turesson,
Department
of
Hematology,
Malmo
Linda Pilarski, University of Alberta, Alberta, Canada
University, Malmo, Sweden
Raymond Powles, Leukaemia and Myeloma, Wimbledon,
Brian Van Ness, University of Minnesota, Minneapolis, MN,
England
USA
Ruben
Niesvizky,
Weill
Medical
College
of
Cornell
Ivan Van Riet, Brussels Vrija University, Brussels, Belgium
University, New York, NY, USA
Robert Vescio, Cedars-Sinai Outpatient Cancer Center, Los
S Vincent Rajkumar, Mayo Clinic, Rochester, MN, USA
Angeles, CA, USA
Donna Reece, Princess Margaret, Toronto, Canada
David Vesole, Loyola University Chicago, IL, USA
Tony Reiman, Cross Cancer Institute, Alberta, Canada
Anders Waage, University Hospital, Trondheim, Norway NSMG
Paul Richardson, Dana Farber Cancer Institute, Boston, MA,
Michael Wang, M.D. Anderson, Houston, TX, USA
USA
Donna Weber, MD Anderson, Houston, TX, USA
Angelina Rodriquez Morales, Bonco Metro Politano de Sangre,
Jan Westin, Sahlgrenska University Hospital, Gothenburg,
Caracas, Venezuela
Sweden
Orhan Sezer, Department of Hem/Onc, Universitatsklinikum
Keith Wheatley, University of Birmingham, Birmingham, United
Charite, Berlin, Germany
Kingdom
John Shaughnessy, M.I.R.T. UAMS, Little Rock, AR, USA
Dina B Yehuda, Department of Hematology, Hadassah
Kazuyuki Shimizu, Nagoya City Midori General Hospital,
University Hospital, Hadassah, Israel
Nagoya, Japan
Jeffrey Zonder, SWOG, Department of Hem/Onc, Karmanos
David Siegel, Hackensack, Cancer Center, Hackensack, NJ, USA
Cancer Institute, MI, USA
Leukemia

Document Outline

International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100)