Vinorelbine plus intermediate dose cyclophosphamide is an effective and safe regimen for the mobilization of peripheral blood stem cells in patients with multiple myeloma

High dose cyclophosphamide (HD-Cy) is commonly used to mobilize stem cells in multiple myeloma ( MM). However, timing of collection is variable and incidence of side effects is substantial. We evaluated a combination of vinorelbine (VNB) ( 25 mg/m(2) day 1) plus Cy (1.5 g/m(2) day 2) and G-CSF as mobilizing regimen in 37 patients with MM. Results were compared to those achieved in 41 previously diagnosed patients mobilized with Cy at 4 g/m(2). Overall, 36/37 patients receiving VNB-Cy (97%) mobilized, as opposed to 40/41 (97%) in the controls ( p: 0.51). Median CD34+ cells peak was 94/mu l for VNB - Cy patients and 96 for controls, p= 0.36; median number of CD34+ cells collected was 9.2 x 10(6)/ kg and 8.7 x 10(6)/ kg, respectively ( p= 0.85). Median number of days to the highest CD34 count was shorter for VNB - Cy patients ( nine vs 11, p= 0.001). No VNB - Cy patient experienced grade 3 - 4 neutropenia and thrombocytopenia, as opposed to 63 and 19% in the controls ( p= 0.001 and 0.01, respectively). Hospitalization from toxicity was never required in VNB - Cy patients as compared to 19% in control group ( p= 0.01). We conclude that an outpatient combination of VNB plus intermediate dose Cy plus G-CSF is a safe, predictable, and highly effective mobilization regimen for patients with newly-diagnosed MM.