Fractionated stem cell infusions for patients with plasma cell myeloma undergoing autologous hematopoietic cell transplantation.
We conducted a phase II trial investigating the impact of fractionated hematopoietic cell infusions on engraftment kinetics and symptom burden in patients with plasma cell myeloma (PCM) undergoing autologous hematopoietic cell transplant (AHCT). We hypothesized that multiple hematopoietic cell infusions would reduce duration of neutropenia and enhance immune recovery resulting in a better tolerated procedure. Twenty-six patients received high-dose melphalan followed by multiple cell infusions (Days 0, +2, +4, +6) and were compared to PCM patients (N = 77) who received high-dose melphalan and a single infusion (Day 0) (concurrent control group). The primary endpoint was number of days with ANC <500K/mcL. Symptom burden was assessed using the MSK-modified MD Anderson Symptom Inventory. Median duration of neutropenia was similar in study (4 days, range 3-5) and control patients (4 days, range 3-9) (p = 0.654). There was no significant difference in the number of red cell or platelet transfusions, days of fever, diarrhea, antibiotics, number of documented infections, or length of admission. Symptom burden surveys showed that AHCT was well-tolerated in both study and control patients. We conclude that fractionated stem cell infusions following high-dose melphalan do not enhance engraftment kinetics or significantly alter patients' clinical course following AHCT in PCM.
['Landau|Heather|H|', 'Wood|Kevin|K|', 'Chung|David J|DJ|', 'Koehne|Guenther|G|', 'Lendvai|Nikoletta|N|', 'Hassoun|Hani|H|', 'Lesokhin|Alexander|A|', 'Hoover|Elizabeth|E|', 'Zheng|Junting|J|', 'Devlin|Sean M|SM|', 'Giralt|Sergio|S|']
D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D016913:Blood Component Transfusion D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D007958:Leukocyte Count D008297:Male D008558:Melphalan D008875:Middle Aged D009101:Multiple Myeloma D019653:Myeloablative Agonists D009503:Neutropenia D009504:Neutrophils D010865:Pilot Projects D013997:Time Factors D019172:Transplantation Conditioning D014182:Transplantation, Autologous D016896:Treatment Outcome
fractionated myeloma transplant Engraftment symptom burden