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4680 Autologous Peripheral Blood Stem Cell Mobilisation Techniques, Stem Cell Yields and Practice Variation-By-Country in Patients with Myeloma Undergoing First Autologous Stem Cell Transplants in EBMT Centres between 2012 and 2021

Program: Oral and Poster Abstracts
Session: 711. Cell Collection and Processing: Poster III
Hematology Disease Topics & Pathways:
adult, Clinical Practice (Health Services and Quality), Plasma Cell Disorders, Diseases, clinical procedures, Lymphoid Malignancies, Technology and Procedures, Human, Study Population
Monday, December 12, 2022, 6:00 PM-8:00 PM

Patrick John Hayden, MD1, Dirk-Jan Eikema2*, Linda Koster3*, John A Snowden4, Denis Caillot, MD5*, Gwendolyn Van Gorkom, MD6*, Laimonas Griskevicius, MD, PhD7*, William Arcese, MD, PhD8, Charles Crawley9, Maurizio Musso10*, Claude-Eric Bulabois, MD11*, Alexander M Martin12*, Tanja Netelenbos, MD, PhD13, Andrew McDonald, MD14*, Johan Maertens15*, Matteo Parma16*, Arpad Illes, MD17*, Cecilia Isaksson18*, Claudia Sossa19*, Joanna Drozd-Sokolowska20*, Kavita Raj21*, Meral Beksac22*, Stefan Schönland23,24*, Donal P. McLornan, MD, PhD25* and Ibrahim Yakoub-Agha, MD, PhD26

1Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Leinster, Ireland
2EBMT Statistical Unit, Leiden, Netherlands
3EBMT Leiden Study Unit, Leiden, Netherlands
4Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
5Centre Hospitalier Universitaire De Dijon, Hôpital Du Bocage, Dijon, France
6Dept. Internal Med.Hematology /Oncology, University Hospital Maastricht, Maastricht, Netherlands
7Department of Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
8Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
9Addenbrooke's Hospital, Cambridge, GBR
10Oncology Department, Hematology and Bone Marrow Transplant Unit, Ospedale La Maddalena, Palermo, Italy
11Service d'Hématologie, CHU Grenoble Alpes - Université Grenoble Alpes, Grenoble, France
12Leicester Royal Infirmary, Leicester, United Kingdom
13Hague Teaching Hospital, The Hague, Netherlands
14Alberts Cellular Therapy, Pretoria East Hospital, Pretoria, South Africa
15University Hospital Gasthuisberg, Leuven, Belgium
16Ospedale San Gerardo, Monza, Italy
17Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
18Umea University Hospital, Umeå, Sweden
19FOSCAL-UNAB, Floridablanca, Colombia
20Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland
21University College London Hospitals NHS Trust, London, United Kingdom
22Ankara University, Ankara, Turkey
23Department of Internal Medicine V, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
24Medizinische Klinik V and Amyloidosis Center, Universitätsklinikum Heidelberg, Heidelberg, Germany
25Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
26Centre Hospitalier Universitaire de Lille LIRIC, INSERM U1286, Université de Lille, LILLE, France

The techniques employed to mobilise autologous peripheral blood stem cells in patients with myeloma have evolved over time and vary between countries. The most common methods are (1) Cyclophosphamide and Granulocyte - Colony Stimulating Factor (G-CSF) (Cyclophosphamide), (2) G-CSF only, (3) G-CSF and Plerixafor, and (4) Other. In general, chemotherapy, usually Cyclophosphamide, is used in Europe and single agent G-CSF in North America.

We performed a retrospective analysis of the EBMT database to analyse stem cell mobilisation techniques in European patients undergoing a first ASCT for myeloma over the last decade. This data was available on a select cohort of patients for whom Med B form data had been submitted.

A total of 76,923 patients received a first autologous stem cell transplant for myeloma in 501 EBMT-affiliated centres between 2012 and 2021. Detailed Stem cell mobilization data including CD34 results were available on 4,710 (M 58%: F 42%) patients from 87 centers. The Median (IQR) age was 61.3 (54.7-66.1) years. MM subtypes were IgG, IgA, Light Chain and Other in 56.6%, 19.2%, 20.8% and 3.4%, respectively. The stage at first transplant was CR, VGPR/PR, SD/MR, and Rel/Prog in 17.5%, 78.4%, 2.8% and 1.3%, respectively.

The frequency of use of each of the stem cell mobilization techniques were as follows: Cyclophosphamide (n=3,017, 67.1%), G-CSF only (n=1,207, 26.9%), G-CSF + Plerixafor (n=222, 4.9%) and Other (47, 1.0%). Peripheral blood stem cells were the sole stem cell source in 4,705 (99.9%) of the transplants.

The comparative median annual CD34 yields (x10e6/kg) are shown below and reveal that the yields following Cyclophosphamide-based mobilization were consistently higher (6.14-7.8) than those following either G-CSF (4.46-6.1) or G-CSF and Plerixafor (2.5-5.6). When analyzed in aggregate, the median (IQR) stem cell yields (x10e6/kg) following Cyclophosphamide, G-CSF, G-CSF and Plerixafor, and Other were 7.32 (4.9-10.14), 5.25 (3.88-7.38), 4.94 (3.42-6.85) and 4.9 (3.82-7.54), respectively.

When analysed by MM subtype, there was no significant difference in yield between the IgG, IgA, Light Chain and Other categories (p=0.523).

We next analyzed the median annual CD34 yields (x10e6/kg) by induction regimen (no. of pts): CTD (Cyclophosphamide, Thalidomide, Dexamethasone) (n=712) 7.56, Other (n=623) 5.86, PAD (Bortezomib, Adriamycin, Dexamethasone) (n=256) 5.8, VAD (Vincristine, Adriamycin, Dexamethasone) (n=172) 5.03, VCD (Bortezomib, Cyclophosphamide, Dexamethasone) (n=1,735) 6.21, VD (Bortezomib, Dexamethasone) (n=603) 5.97, VRD (Bortezomib, Lenalidomide, Dexamethasone) (n=811) 5.42 and VTD (Bortezomib, Thalidomide, Dexamethasone) (n=3,192) 7.12 (p<0.001), the highest yields being collected following CTD and VTD (<0.001).

We finally examined mobilization trends in the seven largest countries in the dataset (France, Germany, Italy, the Netherlands, Spain, Turkey, and the United Kingdom) over time. Data was available for between 9.6% and 22.8% of patients in 6 of the 7 countries; however, it was only available in 2.9% of patients from Germany. Within these clear limitations, there were wide national variations in clinical practice both over time and between countries, as shown below.

Over the last decade, two-thirds of patients in EMBT centres underwent autologous stem cell collection following Cyclophosphamide and G-CSF, one quarter following single agent G-CSF and 5% following G-CSF and Plerixafor. As reported previously, yields were consistently higher following chemotherapy-based mobilization. However, we have no data on associated morbidity such as the incidence of infection, the need for hospital admission or costs. As regards the effect of prior induction regimens, the highest yields were seen in patients who had received either CTD or VTD induction, possibly reflecting less stem cell toxicity due to chemotherapy and/or deeper remissions following these regimens. Finally, limited data on trends in practice appears to show considerable variation between countries combined with significant changes in some countries over the last decade.

Disclosures: Hayden: Amgen: Other: Participation in Advisory Board. Snowden: Novartis: Speakers Bureau; Mallinckrodt: Speakers Bureau; Gilead: Speakers Bureau; Janssen and Jazz: Speakers Bureau; Medac: Membership on an entity's Board of Directors or advisory committees; Kiadis: Other: clinical trial IDMC membership . Griskevicius: Miltenyi Biomedicine: Membership on an entity's Board of Directors or advisory committees. Drozd-Sokolowska: Servier: Honoraria, Speakers Bureau; AbbVie: Honoraria, Speakers Bureau; Janssen: Honoraria; Roche: Consultancy; Sanofi: Honoraria. Beksac: Oncopeptides: Consultancy, Honoraria, Other: Advisory Boards, Speakers Bureau; Amgen: Consultancy, Honoraria, Other: Advisory Boards, Speakers Bureau; Sanofi: Consultancy, Honoraria, Other: Advisory Boards, Speakers Bureau; Takeda: Consultancy, Honoraria, Other: Advisory Boards, Speakers Bureau; Janssen: Consultancy, Honoraria, Other: Advisory Boards, Speakers Bureau. Schönland: Pfizer: Honoraria; Takeda: Honoraria, Other: Travel Support; Janssen: Honoraria, Other: travel support, Research Funding; Prothena: Honoraria, Other: Travel Support, Research Funding. McLornan: CELGENE BMS: Research Funding, Speakers Bureau; ABBVIE: Speakers Bureau; NOVARTIS: Honoraria, Research Funding, Speakers Bureau; JAZZ: Honoraria, Speakers Bureau. Yakoub-Agha: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel Support; Janssen: Honoraria; Bristol Myers Squibb: Honoraria.

*signifies non-member of ASH