Shaji K. Kumar, MD, discusses how patients with multiple myeloma respond to different types of therapy.
Shaji K. Kumar, MD, professor of medicine, Mayo Clinic, discusses how patients with multiple myeloma respond to different types of therapy.
The different approaches used for stem cell mobilization are successful in a majority of these patients, according to Kumar. When physicians granulocyte colony-stimulating factor (G-CSF) alone for mobilization, there is up to 10% failure rate, and the rate goes up if the patient has been treated for a longer period of time and if they have been given treatments such as lenalidomide (Revlimid), alkylating agents, or newer therapies like daratumumab (Darzalex).
For patients who did not experience benefit on G-CSF alone, additional techniques are available, including chemotherapy or plerixafor mobilization. Plerixafor is a CXCR4 targeted agent for patients with myeloma. Kumar says that when plerixafor is used in a risk adapted strategy based on the CD34 counts, after the G-CSF, or based on the number of CD34 cells collected, the failure rate is reduced to 1% to 2% for patients in this setting.
With chemotherapy mobilization, physicians have the opportunity to collect more cells in patients than when using G-CSF alone and the failure rate is lower, Kumar explains. This also has increased cost and toxicity for patients, such as cytopenias, longer time to mobilization, and management of neutropenic fever if it requires hospitalization.
Kumar believes that these different strategies need to be selected based on each individual patient and the clinical context.