Abstract 3469

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

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

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Figure 2.
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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Presence of bacteremia had no effect on neutrophil engraftment (p=.28) but slowed the rate of platelet engraftment platlets P<.001.

Figure 2.
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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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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Disclosures:

Gertz:Celgene: Honoraria; Millenium: Honoraria, Membership on an entity's Board of Directors or advisory committees. Lacy:Celgene: Research Funding. Dispenzieri:Celgene: Honoraria, Research Funding; Binding Site: Honoraria. Kumar:Celgene: Consultancy, Research Funding; Millennium: Research Funding; Merck: Consultancy, Research Funding; Novartis: Research Funding; Genzyme: Consultancy, Research Funding; Cephalon: Research Funding.

Topics:
bacteremia, engraftment, growth factor, hematopoietic stem cell transplantation, multiple myeloma, kinetics, filgrastim, transplantation, albumins, autologous stem cell transplant
*

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© 2010 by The American Society of Hematology
2010
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