Nicotine Use During Mobilization Is Associated with More Efficient Stem Cell Collection

GCSF (Granulocyte Colony-Stimulating Factor) with or without chemotherapy have been mainstays of mobilization protocols. Although effective, plerixafor is very expensive and adds significantly to the cost of stem cell collection. There is a body of literature indicating that nicotine exposure induces mobilization of endothelial stem cells. Additionally, nicotine-induced alterations in hematopoietic stem cell kinetics have also been described in both humans and animal models. A chance observation of a better than expected stem cell collection in a smoking patient prompted us to review our databases and determine if nicotine patch use or smoking had an effect on the success of stem cell collections.

Data was retrospectively retrieved from a local transplant database and the electronic medical records of all male patients with a diagnosis of plasma cell myeloma who had peripheral stem cells collected using GCSF-mediated mobilization at our facility from 2003-June 2009. Data on smoking and the use of a nicotine patch at the time of mobilization, diagnosis, stage of disease, age, days of collection, number of stem cells collected at day 1 and total, previous chemotherapy/radiation therapy and prior response to therapy were collected. Patients who received chemotherapy or plerixafor for mobilization were excluded from the study. If patients had more than one mobilization/collection procedure, only data from the first was analyzed. Smoking/nicotine exposure was determined by review of the medical record and pharmacy prescription logs.

A total of 137 patients with average age of 58.7 ± 7.4 who had undergone stem cell mobilization and collection were identified of whom 13 (9.5%) were determined to have an exposure to nicotine during that time (table 1). Of the 13 patients, one was actively smoking and twelve were using a nicotine patch. Simple logistic regression analysis was used to determine the relationship between day 1 CD34 progenitor cell collection of > 4 million/kg and clinical variables (nicotine exposure, prior alkylating agent, prior radiation therapy, response at transplant, lenalidomide use and Durie-Salmon stage). Nicotine exposure had a significant favorable effect, with p-value=0.0349 (table 2). Further analysis with a multiple logistic regression model indicates that nicotine use was associated with a 3.5 fold favorable odds ratio for the success of stem cell collection ≥ 4 million/kg with adjusting for age, p-value 0.039 (table 3).

In this small retrospective study, nicotine exposure appears to be correlated with improved GCSF-mediated stem cell collection (on the first day of collection) in male patients with plasma cell myeloma. The small sample size makes drawing definitive conclusions difficult, but point to the need for an examination of larger databases to determine if this relationship has validity.

No relevant conflicts of interest to declare.