Optimal approach to stem cell mobilization in transplant-eligible multiple myeloma patients

Abstract

Multiple myeloma is a neoplastic disorder of plasma cells typically afflicting older individuals. Despite significant improvements in induction therapy and outcomes for transplant-ineligible newly diagnosed multiple myeloma (NDMM) patients, autologous stem cell transplant (ASCT) remains the standard of care for consolidation in transplant-eligible NDMM. Consequently, the optimal approach to stem cell mobilization remains critical. In this manuscript, we outline key updates to stem cell mobilization in NDMM patients. We describe the optimal number of cycles of induction prior to mobilization, emphasizing the need to balance the benefit of achieving improved depth of response by giving additional cycles of pre-transplant induction with the impact on stem cell yields. Additionally, we review ideal timing between the end of induction and initiation of mobilization to facilitate both a minimization of time off therapy as well as better communication and work flow between community providers and transplant centers. We also review different stem cell mobilization regimens with and without upfront CXCR4 inhibitors to optimize stem cell yields while considering both clinical outcomes and cost of care. Finally, we review optimal yields of CD34+ hematopoietic stem cells to minimize toxicity for ASCT and also consider optional utilization of stem cells for both salvage second ASCT and stem cell boosts for poor marrow function.