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Karmanos doctors publish article about multiple myeloma therapeutic agent, suggest guideline revisions

Muneer H. Abidi, M.D., medical director of the Hematopoietic Stem Cell Laboratory at Karmanos and WSU SOM 

Researchers at the Barbara Ann Karmanos Cancer Institute have published an article on their study of the use of therapeutic agent lenalidomide on multiple myeloma patients and the decrease in adequate collection of peripheral blood stem cell collection for use in an autologous stem cell transplant.

Lenalidomide (LEN) is a relatively new and very effective induction therapy for multiple myeloma patients. It is, however, associated with an increased risk of inadequate peripheral blood stem cell (PBSC) collection for a stem cell transplant, particularly when doctors use it with filgrastim, the most commonly used agent for PBSC mobilization. Adequate PBSC collection is critical in performing an autologous stem cell transplantation.

The article is titled, “Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma” and it has been published in the journal, “Support Care Cancer.” To read a copy of the research, click

Authors include Divaya Bhutani, M.D., fellow in the Department of Hematology/Oncology at Karmanos and Wayne State University School of Medicine (WSU SOM); Jeffrey Zonder, M.D., leader of the Multiple Myeloma Sub-committee at Karmanos; Jason Valent, M.D., former fellow in the Department of Hematology/Oncology at Karmanos and WSU SOM and now of the Cleveland Clinic; Nishant Tageja, M.D., former internal medicine resident with WSU SOM, now with the National Cancer Institute; Lois Ayash, M.D., clinical professor of Medicine at Karmanos and WSU SOM; Abhinav Deol, M.D., assistant professor in the Department of Oncology at Karmanos and WSU SOM; and Zaid Al-Kadhimi, M.D., associate scientific director of Bone Marrow Transplant and Immunotherapy at Karmanos and WSU SOM.

Fellow authors include Judith Abrams, Ph.D., director of the Biostatistics Core at Karmanos and WSU SOM; Lawrence Lum, M.D., D.Sc., professor of Oncology, Medicine, and Immunology and Microbiology at Karmanos and WSU SOM; Voravit Ratanatharathorn, M.D. and Joseph Uberti, M.D., co-leaders of the Stem Cell and Bone Marrow Transplant Multidisciplinary Team at Karmanos and WSU SOM; and senior author Muneer H. Abidi, M.D., medical director of the Hematopoietic Stem Cell Laboratory at Karmanos and WSU SOM.

Researchers conducted an analysis of 319 patients who underwent a variety of therapy modalities that included various mobilizing agents such as filgrastim; sargramostim and filgrastim; cyclophosphamide and filgrastim; and filgrastim and plerixafor. One hundred and eighty-six patients received LEN in addition to these mobilizing agents and 133 patients did not prior to PBSC collection.

The authors also administered various numbers of induction regimens prior to PBSC collection among the LEN positive and negative groups. They found that the median number of apheresis sessions required to collect adequate amounts of PBSCs were significantly higher in the LEN positive group as compared to the LEN negative group, indicating that LEN is associated with a higher risk of PBSC failure.

Recently published guidelines from the International Myeloma Working Group recommend PBSC collection after about four cycles of LEN induction therapy to minimize the risk of PBSC collection failure. Karmanos researchers, however, found that five or more prior cycles of LEN were associated with a drop in PBSC yield but did not pose a negative impact on the ability to collect the minimum amount of PBSCs required to perform an autologous stem cell transplant.

In conclusion, study data shows that filgrastim can be used to successfully mobilize PBSCs in multiple myeloma patients following LEN therapy. And, because researchers did not find that more than four cycles of prior LEN therapy had a negative impact on adequate PBSC collection for an autologous stem cell transplant, they are suggesting a re-evaluation of current guidelines they say erroneously limit the number of cycles of LEN induction therapy regardless of response.

Furthermore, they demonstrated that multiple myeloma patients who received LEN induction therapy and then underwent a stem cell transplant with an adequate PBSC dose had normal marrow recovery.

“These issues must be addressed in prospective clinical trials as more multiple myeloma patients are exposed to prolonged durations of LEN in the setting of delayed autologous steam cell transplant and maintenance therapy,” authors write.

The authors’ research also has been reviewed by the Myeloma Beacon, an online resource for multiple myeloma patients, their families and other interested parties. To read the article, click

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