Mobilization of peripheral blood progenitor cells with vinorelbine and granulocyte colony-stimulating factor in multiple myeloma patients is reliable and cost effective

Abstract

Cyclophosphamide with granulocyte colony stimulating factor (G-CSF) is commonly used to mobilize stem cells in multiple myeloma. Timing of collection is variable and incidence and severity of side effects is substantial. To optimize timing of collection, to reduce side effects and to limit costs of the procedure, we evaluated vinorelbine, a drug shown to have activity in multiple myeloma, in combination with G-CSF as mobilizing regimen. A total of 19 consecutive patients with advanced stage multiple myeloma received one dose of vinorelbine 35 mg/m² intravenously on day 1 in an outpatient setting and G-CSF 10 μg/kg/day from day 4 divided in two daily doses. Median CD34+ cell blood counts measured on day 8 of mobilization were 142×10⁶/l (range 57–467). One 15-l apheresis on day 8 resulted in sufficient stem cells (median 11.1×10⁶ CD34+ cells/kg, range 6.2–36.0 prior and median 7.5×10⁶ CD34+ cells/kg, range 4.0–20.2 postpositive CD34+ cell selection) for transplantation. Hematopoietic recovery was swift with ANC >0.5×10⁹/l on day 11 median (range 10–15) and platelets >20×10⁹/l on day 12 median (range 10–15) after reinfusion of the stem cells on day 0. No episodes of febrile neutropenia were observed during mobilization. In our institutions cost reduction for the procedure was about 1700 euros compared to the mobilization with cyclophosphamide and G-CSF. Vinorelbine and G-CSF allow precise timing and harvesting of sufficient stem cells, and might be an alternative to cyclophosphamide in the mobilization of stem cells for autologous transplantation in multiple myeloma.