Efficient mobilization of peripheral blood stem cells following CAD chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma

High-dose chemotherapy followed by autologous blood stem cell transplantation is the standard treatment for myeloma patients. In this study, CAD (cyclophosphamide, adriamycin, dexamethasone) chemotherapy and a single dose of pegfilgrastim (12 mg) was highly effective in mobilizing peripheral blood stem cells (PBSCs) for subsequent transplantation, with 88% of patients (n=26) achieving the CD34+ cell harvest target of ⩾7.50 × 106 CD34+ cells/kg body weight, following a median of two apheresis procedures (range 1–4) and with first apheresis performed at a median day 13 after CAD application (range 10–20). Patients treated with pegfilgrastim showed a reduced time to first apheresis procedure from mobilization compared with filgrastim-mobilized historical matched controls (n=52, P=0.015). The pegfilgrastim mobilization regimen allowed for transplantation of a median of 3.58 × 106 CD34+ cells/kg body weight while leaving sufficient stored cells for a second high-dose regimen and back-ups in most patients. Engraftment following transplantation was comparable to filgrastim, with a median time of 14 days to leucocyte ⩾1.0 × 109/l (range 10–21) and 11 days to platelets ⩾20 × 109/l (range 0–15). The results of this study thus provide further support for the clinical utility of pegfilgrastim for the mobilization of PBSC following chemotherapy in cancer patients scheduled for transplantation.