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Blood, Vol. 94 No. 4 (August 15), 1999:
pp. 1218-1225
Stem Cell Factor in Combination With Filgrastim After Chemotherapy
Improves Peripheral Blood Progenitor Cell Yield and Reduces Apheresis
Requirements in Multiple Myeloma Patients: A Randomized, Controlled
Trial
Thierry Facon,
Jean-Luc Harousseau,
Frédéric Maloisel,
Michel Attal,
Jesus Odriozola,
Adrian Alegre,
Wilfried Schroyens,
Cyrille Hulin,
Rik Schots,
Pedro Marin,
François Guilhot,
Albert Granena,
Marc De Waele,
Arnaud Pigneux,
Valérie Méresse,
Peter Clark,
Josy Reiffers, and
the SCF-Multiple Myeloma Study Group
From the Departments of Hematology of Lille, France; Nantes, France;
Strasbourg, France; Toulouse, France; Madrid, Spain; Antwerpen,
Belgium; Vandoeuvre-les-Nancy, France; Brussels, Belgium;
Barcelona, Spain; Poitiers, France; L'Hospitalet, Spain; Pessac,
France; Amgen, Paris, France; and Cambridge, UK.
Stem cell factor (SCF) has been shown to synergize with filgrastim
to mobilize CD34+ cells into the peripheral blood. To
determine if addition of SCF to chemotherapy and filgrastim reduces the
number of leukaphereses required to achieve a target yield of 5 × 106 CD34+ cells/kg, 102 patients with
multiple myeloma were randomized to receive mobilization chemotherapy
with cyclophosphamide (4 g/m2) and either SCF (20 µg/kg/d) combined with filgrastim (5 µg/kg/d) or filgrastim alone
(5 µg/kg/d), administered daily until leukaphereses were completed.
After collection, patients were treated with myeloablative therapy
supported by autologous peripheral blood progenitor cell (PBPC)
infusion and filgrastim (5 µg/kg/d). There was a significant difference between the treatment groups in the number of leukaphereses required to collect 5 × 106 CD34+ cells/kg
(median of 1 v 2 for SCF + filgrastim and filgrastim alone,
respectively, P = .008). Patients receiving the combination of SCF plus filgrastim had a 3-fold greater chance of reaching 5 × 106 CD34+ cells/kg in a single leukapheresis
compared with patients mobilized with filgrastim alone. The median
CD34+ cell yield was significantly increased for the SCF
group in the first leukapheresis (11.3 v 4.0 × 106/kg, P = .003) and all leukaphereses (12.4 v 8.2 × 106/kg, P = .007). Total
colony-forming unit-granulocyte-macrophage (CFU-GM) and
mononuclear cell counts were also significantly higher in the SCF group
in the first leukapheresis and in all leukaphereses. As expected for
patients mobilized to an optimal CD34+ cell yield, the
time to engraftment was similar between the 2 treatment groups. Cells
mobilized with the combination of SCF plus filgrastim were thus
considered effective and safe for achieving rapid engraftment.
Treatment with SCF plus filgrastim was well tolerated, with mild to
moderate injection site reactions being the most frequently reported
adverse events. There were no serious allergic-like reactions to SCF.
The addition of SCF to filgrastim after cyclophosphamide for PBPC
mobilization resulted in a significant increase in CD34+
cell yield and a concomitant reduction in the number of leukaphereses required to collect an optimal harvest of 5 × 106
CD34+ cells/kg.
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