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Go Directly to Chemotherapy That Will Mobilize Stem Cells Early in Disease Course

Go Directly to Chemotherapy That Will Mobilize Stem Cells Early in Disease Course

LITTLE ROCK—"For the first time, we have shown that with
increasing age, the number of stem cells mobilized decreases," said
Guido J. Tricot, MD, PhD, reporting the results of a multiple myeloma study
(ASCO abstract 1055). Clinicians can compensate for the decrease, however,
by using chemotherapy early in the disease course to mobilize stem cells, he
advised.

Dr. Tricot is head of the Academic Division of Myeloma Transplant,
Myeloma Institute for Research and Therapy, University of Arkansas for
Medical Sciences in Little Rock. As part of a study of 984 multiple myeloma
patients, the team led by Dr. Tricot looked at peripheral blood stem cell
mobilization in 106 elderly patients at least 70 years of age.

"Most clinicians reserve mobilization followed by transplantation
for the younger patients and treat the older ones with conventional
therapies first, using transplantation only as a last resort. This is the
wrong approach because by the time older patients go through conventional
therapy, their own resources are depleted," Dr. Tricot said. "They
have a much better chance if it’s done earlier. If we can collect stem
cells early in the course of multiple myeloma, chances of having a higher
platelet count and good outcome are much better, even in older
patients."

Favorable Variables

Standard therapy of less than 12 months and platelet count at least
200,000/µL before mobilization were identified by multivariate analysis as
favorable variables predicting better outcome. Among patients who had both
favorable variables, 85% had adequate collections of at least 4 × 106
CD34+
cells/kg after a median of one collection. Among all 106 elderly patients,
70% had successful collections of at least 4 × 106 CD34+ cells/kg after a
median of three collections.

Chemotherapy-based mobilization significantly increased the yield of CD34+ cells compared to growth factors alone, but only in patients who had
both favorable variables. "Using growth factors and other agents, we
can manipulate the outcome, but one thing we can’t change is the patient’s
age," Dr. Tricot said. "The number of stem cells decreases with
age, but we can compensate by mobilization with chemotherapy very early in
the disease."

Incremental Effect of Age

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